Diver Medic Magazine Issue 6 Nov 2015 by Diver Medic and Aquatic Safety

Editor-in-ChiEf Chantelle Newman tEChniCal EditorS Andrea Zaferes, Gareth Lock dESignErS Allie Crawford, Sarah Crawford MEdiCal and diving SpECialiSt ConSultantS Dr Anke Fabian Dr Adel Taher and Dr A Sakr diving ConSultantS Dan and Betty Orr Jill Heinerth advErtiSing and SubSCriptionS Chrissie Taylor Newman ContributorS thank you to thE following ContributorS: Cover Designed by Anna Burn, Amanda Cotton, Cristina Zenato, Andy Davis, Andrea Zaferes, Dr Anke Fabian, Yvonne Tatchley, Betty Orr, Dan Orr, Jill Heinerth, Ellen Cuylaerts, Gareth Lock, Matt Smith, Brandon Johnson, Rod Hancock, Code Blue Nurses, Dan Consulting, WDHOF, SUUNTO, Aquamed, Fourth Element, Niki Holt

photographErS Cover Image by Amanda Cotton Amanda Nicholls, Roy Pedersen, frantisekhojdysz, zhu difeng, Dudarev Mikhail, Andrea Izzotti, Rich Carey, Gareth Lock, LauraD, Stephen Kerkhofs, Ciro A, Teemu Virtanen, Jayne Jenkins, Michael-Maes-MPM, Ellen Cuylaerts, Arek Pers, Stephen Frink, Amanda Cotton, NYD Norway, Daniel Van Duinkerken

Contents 4 TASK LOADING: Getting The Shot Safely 6 Serious Overheads 16 Body Language 22 Master your fate - The Four Stages of Learning 30 The Icarus Effect - Part 1 36 Tangled Hoses & Boat Propellers 46 The Titan Trigger Fish 52 CASE STUDY: A triggerfish encounter 58 Single Cylinder Entanglement 64 A Failure To Communicate 72 Equalisation & Ascent 78 Little Nemos 84 Letter from Editor

By Chantelle Newman

By Amanda Cotton By Cristina Zenato

By Ellen Cuylaerts By Jill Heinerth By Andy Davis By Matt Smith

By Yvonne Tatchley By Dr Anke Fabian

By Gareth Lock

MagazinE addrESS The Diver Medic Ltd Great West House, Great West Road, Brentford, TW8 9DF tElEphonE +44 020 8326 5685 EMail info@thedivermedic.com www.dmaasm.com www.thedivermedic.com

By Dan Orr

By Andrea Zaferes By Niki Holt

Letter from editor Those of you who’ve been supporting Diver Medic And Aquatic Safety Magazine for just over a year have likely noticed its new name and style. We felt it was time for a refresh of the magazine to really reflect what we’re trying to do, but the content and focus remain the same: exploring the realms of safety, education and diving medicine—issues close to all of our hearts. Diver Medic magazine is the only publication dedicated to people from all disciplines of diving, water safety and rescue. Our aim is to create an open dialogue within our broad community, to improve diver safety and reduce diving incidents. For that reason, the magazine is now free. Safety and wellbeing are priceless, and we want to open up the conversation to all. We’re honoured to have a truly incredible group of contributors who are experts in their fields and we feel it’s essential that access to their insight is not limited. This new issue is packed full of advice, tips and case studies from across the diving spectrum. There’s a new section on commercial diving by Matt Smith (page 46). Something a little different from world-renowned photographer Amanda Cotton on page 6 (the cover image might have given it away!). And a thoughtful piece from Andy Davis on dangerous team dynamics, following on from the tragic death of Doc Deep (Dr Guy Garman) during a world record attempt in August 2015 (page 36). This last one is a must-read for all those involved with dive support teams. On a final note: If you enjoy reading this magazine, please lend your support by spreading the word amongst your network. A free magazine still costs time and money to create, so we need to make sure we’re reaching as many potential advertisers as possible. Diver Medic magazine is dedicated to all of you, our readers. And the knowledge that together we can share, learn and save. Thank you and dive safe always.

We are please to announce that Chantelle Newman will be inducted into the Women Divers Hall of Fame in April 2016 along with Dawn Kernagis, Patti Kirk Gross, Laura James, Ruth Petzold and Cody Unser. Women Divers Hall of Fame are dedicated to recognizing and honoring the contributions of women divers, the Women Divers Hall of FameTM (WDHOF) is an international, non-profit, professional honor society whose members’ achievements span a wide variety of fields including: The Arts, Science, Medicine, Exploration & Technology, Marine Archeology, Business, Media, Training & Education, Safety, Commercial & Military Diving, Free Diving, and Underwater Sports.

Photo by NYD Norway

Chantelle Newman Editor in Chief

Photo by Amanda Cotton

TasK LOaDING Getting The shot safely Capturing the perfect image underwater can seem like mission impossible. It can feel like the odds are stacked against you when fighting sCuba and camera gear, challenging ocean conditions, and dealing with uncooperative marine life! aMaNDa COTTON takes you through the dos and don'ts.

Creating beautiful photography underwater requires all of the same skills that topside photography demands, but there are added difficulties. By utilising some tried and tested tips and focusing on several important points prior to diving with a camera, you can combat issues related to task loading and achieve results youâ&#x20AC;&#x2122;ll be thrilled to share with family and friends.

proper training and experience, shooting underwater tests the limits of the most accomplished divers. Being prepared for the unexpected and knowing how to cope in a stressful situation can mean the difference between coming back with the shot or not coming back with the shot.

Giving more gear to any diver without proper experience and training in the water adds stress to a dive. Even with

Getting your scuba certification is an exciting achievement and exploring the new underwater world

ProPer dive training

Photo by Amanda Cotton keeps many new divers clamoring to experience more. But taking on too much, too soon, can inhibit the learning process. There is no substitute for experience, which can only come from time in the water. Focusing on enhancing our skills as divers should be first and foremostâ&#x20AC;&#x201D; especially when newly certified. Bringing a camera into the mix before a diver has mastered fundamental skills, such as buoyancy and problem solving, should be avoided. One of the best

things an aspiring underwater photographer can do for their imagery is develop their diving skills. Continued training and certifications are a perfect way to speed up this process. The better a diver you are the better a photographer you will be. Positioning in the water, control of movement, trim above delicate reefs and marine life; all these skills help achieve better results for both your dive experience and your photography.

Water skills should never be underestimated. Physical fitness goes a long way in both diving and underwater photography. We quickly realise this when swimming hard after a fast-moving animal like a whale, dolphin or sailfish in the thrill of the chase. If you can’t keep up with the marine life, you’ll miss many of the best opportunities for once-in-a-lifetime captures. Being physically fit will also help in handling demanding situations like strong currents, rough seas and challenging conditions. Honing your freediving skills can help dramatically, especially when attempting to shoot marine life while at the surface or on a snorkel. Having great skills in freediving will vastly improve your ability to get close to marine animals, with the lack of bubbles causing little-to-no disturbance to them. Learn your gear The fastest route to frustration underwater can be trying to problem-solve an unexpected issue; little problems spiral out of control if not dealt with quickly and confidently. Knowing your camera gear, understanding settings and controls, and being prepared with backup plans will help dissolve stressful situations when they inevitably arise. Learn and understand your camera and its functions before you take it underwater. Knowing button locations and functions thoroughly will alleviate many issues and delays when you take your camera rig with you on a dive.

Ultimately you’ll want to be so comfortable with the mechanics of your housing and camera that changing functions and settings will become second nature to you. This too will reduce task loading issues underwater. Spend time during your safety stops practicing with your gear, switching between camera tasks and dive gear tasks while maintaining buoyancy control. A lot of time underwater is spent on your ascent—time that can improve skills greatly, if used to our advantage. Know your subject Understanding the behavior of the marine life we’re trying to shoot can help in capturing images in the safest and most efficient way while creating as little stress and disruption to marine life as possible. A little research prior to a dive or dive trip goes a long way toward figuring out what to expect from different species in the oceans. Are you heading off on a shark diving trip to photograph tigers for the first time? Learning about behavior that is specific to tiger sharks, as well as the behavior of sharks in general, can help you get the money shot you’re after. Reading up in journals or online is a great way to quickly learn about different marine life, as is contacting divers who have previously encountered the species you’re looking to photograph. Don’t be afraid to ask questions and learn from those with experience; they will know what to watch for, what the common behaviours are, and what unique behaviors exist in a specific location.

Photo by Amanda Cotton

Harassment of marine life should be avoided at all times. Frightened or distressed wildlife can react poorly and without warning, causing an immediate and serious threat to a photographer and those around themâ&#x20AC;&#x201D;not to mention to the subject itself. Caution should be taken at all times to ensure the safety and wellbeing of marine life and those in the water with it. safety first, aLways: It isnâ&#x20AC;&#x2122;t just about getting great images. Divers who jump, camera in hand, without properly preparing to shoot

underwater can put both themselves and those around them at risk. A distracted and unprepared diver is an accident waiting to happen. Itâ&#x20AC;&#x2122;s important to take care and fully prepare for the extra demands introduced when shooting underwater. Safety should be at the top of the agenda when diving, be it on scuba or freediving, with or without a camera. No dive is worth your life and the same holds true for a photograph. Things escalate much faster underwater than on land. A ripping current in a new dive location, distracted dive buddy, or malfunctioning strobes could quickly leave an ill-prepared photographer, focused on camera issues, in a precarious situation and open

Photo by Amanda Cotton to a dangerous outcome. Remember to prioritise what matters most in any given shooting situation. Safety first, always. Diving above your skill level or in environments you’ve not specifically trained for can quickly lead to problems. Unique dive sites such as caves, overhead ice, and deep reefs and wrecks can be tempting to the underwater photography enthusiast, but without proper training these sites could prove deadly. Additional training to access these sites for photography aims is a must.

Depth is an area that is often taken for granted when your log book starts to fill. Even when you’re familiar with all the gear, know the location of your camera controls, and are able to consider your buoyancy control while focused on other tasks, things will get more complicated the deeper you go. We all learned about nitrogen narcosis in our training and many of us have advanced training for deep dives but, when you’re after subjects in deeper water, the extra task loading due to nitrogen levels is very real. Dozens of hours photographing tiger sharks at 7m will certainly give you some experience, but not enough to be prepared to shoot in the same way 30m with great hammerheads.

As you transition into new environments, it is important to remember the steps you used to build your experience in previous environments. Reduce your expectations and let photography be secondary while you get comfortable. Focus on the new environment first. Finding competent dive buddies to assist you while shooting underwater will also benefit your photography. Having a great dive team with you can significantly reduce the potential stresses that inevitably happen when task loading. A good buddy, especially one who will watch your back while you focus on getting the shot, can do wonders. A buddy doesn’t replace your responsibility for your own safety, but a second set of eyes can help you maintain good judgement and stick with your dive plan … even when the subject won’t cooperate! Attempting to create underwater photography that you’ll be thrilled to share with the world, your family, and friends starts long before you pick up a housed camera and go for a dive. It takes time, attention to detail, and dedication to do it safely and with as little impact on the oceans and marine life as possible. As divers, ocean enthusiasts, and underwater photographers, our primary concern should be the mastery of our skills so that our adventures are an enjoyable and positive experience for the marine life we encounter, those we dive with and, of course, ourselves. “take only pictures, leave only bubbles.”

Photo by Amanda Cotton

'Reduce your expectations and let photography be secondary while you get comfortable. Focus on the new environment first.'

Photo by Arek Pers

Issue 6 | November 2015

SERIOUS

OVERHEADS Conscious Cave Diving By Christina Zenato

The tank sits heavily on my shoulder. My feet struggle to follow my buddy's long-legged pace up the path. Rolling thoughts threaten to overwhelm my breathing. A man died in a cave. He was found out of air, covered in clay and heading away from the entrance. He died alone, in darkness.

ith each of these thoughts, I feel panic rising. Breath accelerates. I wish I could reach out my hand and touch him on the shoulder, tell him it will be all right. I wish I could be there in the final moments; a silent and warm final touch. Nobody goes cave diving thinking it’s their last dive, their final breath. Nobody. But tonight I can’t stop wondering. My panic level is threatening to make me call it. I don’t want to die in a cave, not tonight, not any time soon. I don’t want to feel it coming. I don’t want fear to be my last emotion. My thoughts wash over me like a massive wave breaking on a solid reef. I stumble, I breathe, and I feel death. I am afraid. In silence I get ready and review the plan. I keep my thoughts to myself. Final walk to the entrance, time to set the gear. Clip, check, breath. Clip, check, breath. Should I? Lights, air, check. Should I call it? Check buddy. Check plan.

Check reels. Should I call it right here, right now? Check. Ready. Check. Descend. Lights reveal a familiar landscape, the reel rolls in my hand. I become aware of breathing. The gear settles into the right position. Kick. Tanks solid at my sides. Kick. Okay signal from my buddy. Kick. My heart rate settles to a steady rhythm. Kick. The darkness of the cave absorbs the light, shadowing my darkest thoughts. I know how to do this. I know how this feels. I am home. Kick. Check on my gauges. A warm hand touches my shoulder; I feel peace in my heart, peace in my thoughts. We’re here, we’re diving; no room for anything else. Kick. Elegant fauna flutters as we pass. Kick. Blurred images settle in the halocline, clear thoughts settle in my heart. Kick. Time ticks by.

Photo by Stephen Frink

Death: part of life Cave diving: Part of my life In September 2009, a man died while cave diving in Florida. He was fully trained for overhead environments. He was wearing all the correct gear. But something happened. After his death, the cave diving community probed for answers and a relentless string of analysis, opinions, reviews and comments followed. Accident analysis is the bread and butter of this particular diving discipline. Created in the USA by cave explorer and legend Sheck Exley, and extended by Wes Skyles, accident analysis takes into consideration the different factors, both direct and indirect, that may have caused a fatality. As a group, cave divers faithfully subscribe to a series of strict rules and training procedures developed through a detailed and careful analysis to prevent unnecessary deaths. So, taking all this into account, why is cave diving still so dangerous?

Balance

All diving activity requires a balance of skill, well-maintained gear, and a focused mindset. This is doubly true for cave diving. When any one of these elements is misaligned, risk increases. The main difficulty with overhead environments is

that there’s no direct ascent to the surface and, possibly, a long swim back to the entry point. A minor failure here can quickly become life threatening. As I tell my students, ‘misery loves company’. Little issues and oversights, which result in a small failure, can create an avalanche effect.

Skill

If skills in open water are important, then in cave diving they are vital. Cave divers must be extremely proficient in their buoyancy control, their body positioning, and their handling of every piece of gear—from their mask to the lights they carry. And they practice, practice, practice and then, practice some more. Adhering to the parameters set by your level of training is fundamental to diving in overhead environments.

Equipment

When it comes to equipment, it is not a case of one-size-fitsall. Cave divers must carry specialised apparatus, suitable for specific environments and, often, unique to the individual. Whether you dive in a dry suit or a 3mm, in the Bahamas or in frozen caves of Sweden, use side-mount or back-mount tanks, your equipment needs to be like a second skin, it has to perform at its best, and it must be well-maintained. Cheap gear and cave diving don’t go well together; it’s a question of how much you feel your life is worth.

Photo by Arek Pers

Mindset The final requirement for safe and successful cave diving is a focused mind. This includes the ability to maintain detailed focus on gear as well as global awareness of, and the means to accurately read, the environment, technical data, and communications with diving companions. Global awareness describes an ability to pay close attention to the vast number of constantly changing details that occur during a dive. To succeed in this environment requires both consistent effort and continual adjustments. Reading the environment—in other words, having a good sense of spacial awareness, which includes factors such as anticipating where to swim, adapting quickly to changes of direction or depth in tunnels, dealing with currents or lack thereof, keeping trim to avoid damage, and understanding how you and your gear relate to your surroundings—is crucial. Environmental awareness also extends to the gear we carry and the technical data a diver needs to monitor while in an overhead situation. Technical data includes gas intake (the need to consider return time in terms of gas and decompression requirements) and depth perception. The latter is one of the most difficult skills to acquire but in a world surrounded by walls, the only true way to determine depth is to monitor your devices. Regarding gear and mindset, it’s important to check everything prior to leaving the surface. Cave divers always carry extra gear and while it may be redundant on the dive, for example a spare mask, they definitely don’t want to

find themselves several thousand feet inside a cave without appropriate emergency gear. The final point to make in relation to mindset is the importance of paying careful attention to your dive companions and vice versa. This mutual assessment of physical and mental indicators encompasses body positioning, light movement, response to input, finning and swimming techniques, repetitive behaviour indicating an increase in stress level, breathing patterns and many more. The more familiar you are with your buddy’s dive physiognomy, the better able you will be to spot the clues as to whether they may be in difficulty. Divers have different stress responses to situations. Many apply a value to potential issues prior to the dive to enable them to quickly decide on a course of action. Some use the method of three; where the dive is called after three possible problems are encountered. Others use the pie method; where each issue is allocated a slice of a pie and the dive is postponed, aborted or cancelled when they feel too large a portion has gone. Fundamentally, cave diving is a serious head game. It requires a deep self awareness of your preparedness, ability, physical and mental reactions to challenges and changes both above and below the surface, and crucially, the willingness to walk away. Having the confidence to call a dive could save your life and ensure that cave diving remains a part of that life.

BODY LANGUAGE When award-winning underwater photographer Ellen Cuylaerts was forced to make the difficult choice between diving and her health, it opened a new chapter in her life, her work and her relationship with the sea. on being bitten by the diving bug After moving from Europe to the Cayman Islands with my family in 2009, snorkelling quickly became a favourite pastime. A year later, I was bitten by the diving bug and, together with my daughter, gained certification. We all love the ocean, but it was clear we would not become a diving family. Following a stressful diving incident, my husband Michael (a diver for 18 years) preferred to stay at the surface, and our young son experienced problems with his ears. In 2011, when my brother visited the island, I jumped at the opportunity to book a Discovery dive for him and a refresher course for me and Michael. We used rental gear and enjoyed our shallow dive but I remember ascending and telling my brother that Iâ&#x20AC;&#x2122;d rather breathe on land. There was no question of my attraction to the big blue and

I had conquered my fear of water, but I felt achy. A friend suggested that I might feel more confident if I bought my own BCD and regulator. So I did and promptly booked several PADI specialties including peak performance buoyancy, deep diving, fish ID and navigation. To reward and motivate myself, I added underwater photography and bought an Olympus EPL. On dive number 17, my instructor felt I was ready for my first photo dive. That was the point of no returnâ&#x20AC;&#x201D;I loved it! Being rocked in the ocean cradle and capturing my experience of this wonderland became my passion. I spent all of my free time reading about diving and photography and, after my first year of diving, booked a workshop with photography master, Dr Alex Mustard, won my first local awards and visited the Birmingham Dive Show, where I met some amazing people in both the dive industry and underwater photography world.

Photo by Ellen Cuylaerts

'Despite being shallow and slow, the first two dives of day one totally wrecked me. Thinking it was jetlag, I went to bed early.'

once bitten ... Arriving back in Cayman, Michael and I planned to spend the following few days taking underwater images for an English conservation project. Despite being shallow and slow, the first two dives of day one totally wrecked me. Thinking it was jetlag, I went to bed early. The second dive of day two was at a dive site I really love, a place where lots of sharks hang out. Prepared for the extra adrenaline, I was hyper-aware and in control of my bottom time and air use. Michael had decided to stay down a little longer, so, being a good buddy, I waited for him at 6m. Besides, the boat was easy to access and visibility was great. But I was cold and during his ascent, I signaled to ask if he would buddy-up with the other divers still at their safety stop. As I ascended, I forgot to put air in my BCD, something I never do. And approaching the boat, I missed the bar and with nothing to hold on to, almost went back down without even realising it. Clearly something was seriously wrong with me. With a heavy heart, I cancelled the following day’s diving. At home, I was barely able to cook for the family and the next day I lay immobile on the couch, my concentration gone. I couldn’t even get my thoughts together to call a doctor. Another day like this followed and that evening, Michael had to push me upstairs to bed where I collapsed with exhaustion. The next morning I woke up crying and asked Michael to drive me to the hospital. At A & E, I failed simple tests—walking a line, standing on one leg, touching my nose—things my daily yoga training should have made easy. After days of blur, it was a relief to lie down on a stretcher and receive oxygen. I wished I could stay there forever.

But within the hour, I was in the hyperbaric chamber for a 5.5h Table 6 treatment. Two more would follow. I was diagnosed with DCI Type 2, which explained why I didn’t feel pain in my joints and only experienced extreme fatigue, loss of concentration and short-term memory loss. Lots of couch time at home followed. Concentration and memory problems persisted and even the most simple chores felt like running a marathon. The laundry took a day. I forgot how to cook dinner. I lost basic, automatic processes. The aftermath of the bend was hard on both my body and my psyche. Letting go and asking Michael to help me in daily life was a must. ... twice shy After six weeks. I got the okay to dive again. My dive profile had been conservative and my hit was classified as undeserved. The heart echo also showed nothing to worry about. As a precaution, I switched to a Waterproof wetsuit to help preserve my body temperature during consecutive dives. I was ready. A shallow, slow dive with a macro set-up was the plan, but after 30 minutes at 9m my right arm started trembling making it impossible to hold the camera and my hand refused to click the shutter. I had to abort the dive. A doctor’s visit confirmed that the tissue damage to my arm was more severe than initially presumed and exercise to strengthen my muscles was advised. Three months after my bend, we visited the manatees of Crystal River for a snorkelling trip, a tip Alex Mustard gave me when I was still in the hospital. If I couldn’t dive, I hoped underwater photography could also work in the snorkel zone. And it did.

Photo by Ellen Cuylaerts

'I loved being free in the water. With big animals, the need to anticipate their behavior is essential just to get any shot — a good shot is hard work.'

The water was cold but the encounters, warm. The passive observation, connection and interaction, initiated by the manatees, showed in our images. No dive gear to worry about, no depth, no tanks and I didn’t miss the diving. Next up was a long-standing trip to Raja Ampat. I decided to keep it super shallow and communicated that to our guides. Unfortunately, our first dive was a swim through starting at 14m. I signalled our guide that I would follow above, tracking their bubbles, but was told that, due to the current, it wasn’t possible, we needed to stay together as a group. I decided then and there this was my last ‘dive trip’—from now on, I would make my own diving decisions. I don’t mind sitting out a dive for the benefit of the group, but no peer pressure underwater for me! Back home, diving became more frequent again. My arm started to heal and I felt okay. To capture my favorite subjects, rays and silversides, I felt I needed to work on my skills and was looking forward to another workshop on Grand Cayman. But the heavy program of four dives a day was too much and the fatigue came back for months. I dragged myself around, took vitamins, had difficulty juggling daily life, but also had wonderful new experiences in the snorkel zone with sharks. Then, a new challenge presented itself. On one of my dives, I experienced alternobaric vertigo. The specialist suspected a sinus problem and suggested surgery. At this point, fed up with doctors, I decided to focus on snorkelling trips over the next year, with bigger animals including sperm whales and dolphins.

I loved being free in the water. With big animals, the need to anticipate their behavior is essential just to get any shot—a good shot is hard work. Using the available light at the surface to create the mood, I was presented with a whole new learning curve. Knowing I had to be kind to my body, I limited diving to good causes or assignments. This was often difficult to explain to other divers who sometimes presumed I was arrogant or that I didn’t want to dive with them. Few people understood, but I knew what I felt. third time LucKy In summer 2014, I started getting major palpitations brought on by stress. Just to be sure everything was okay, I was tested inside and out. This is when I was diagnosed with a small PFO (Patent Foramen Ovale) and a mitral valve prolapse with mild regurgitation. It was a relief to finally understand why diving disagreed with me. I couldn’t wait for surgery. Lots of doctors with different opinions followed. Those who didn’t know me, couldn’t wait to get me in the operating room. But the ones who did, who understood my precious family (my teenagers and husband have high functioning autism), advised me to really think it through and to be grateful for what I had. Why put myself at risk without any guarantees?

Photo by Ellen Cuylaerts

Issue 6 | November 2015

it hit me hard, because they were right. As I do with all things in life, I went back to my essence. I chose not to focus on the negative or what wasn’t possible but to follow the path of new potential. Afterall, the goal of my photography was not diving but to capture beautiful and intense encounters with marine life. I wanted to give back what the oceans gave me, a sense of healing. By showing their wonders to the world I felt sure that more people would come to love and protect the precious balance of the seas. Because of my health issues, I now spend more time out of the water contributing to awareness and education, both key to conservation. I also choose my subjects following certain guidelines: which animals need more attention, are hard to get to, don’t have a lot of images taken of them in the wild, etc. The journey brought me to the cold, to orcas, belugas and harp seals, and that’s just the start! Before the involvement of doctors, my body was telling me something: to slow down on the diving and relocate to surface waters. And it’s been a revelation. I’ve found that there is a life in the ocean for non-diving underwater photographers—and that reinventing my life every few years is invigorating! I’m glad I listened.

Photo by Jayne Jenkins

'Because of my health issues, I now spend more time out of the water contributing to awareness and education, both key to conservation.'

Photo by Michael-Maes-MPM

Photo by Ellen Cuylaerts

Issue 6 | November 2015

Photo by Teemu Virtanen

Master YOUR

FATE The Four Stages Of Learning Jill Heinerth, cave diver and underwater explorer, applies the Gordon Model for training to the diving learning curve. Noel Burch of Gordon Training International is widely considered to be the originator of the Conscious Competence Learning Model, which describes the required psychological steps of embedding any new skill from a point of complete incompetence to competence or mastery. Applying these steps to your dive training journey can be a useful tool for assessing ability, while helping you avoid stumbling blocks along the way.

STAGE 1: Unconsciously incompetent or unaware and unskilled In order to learn a new skill, we have to first recognise our inability to perform the skill; to admit to not knowing. On the first day of training, a diver doesn’t know how to set-up and use his equipment, assess risk—and he also doesn’t understand the extent of

his lack of knowledge. Having a little knowledge, can be a dangerous thing if a new diver assumes that what he does know is enough. He could put himself at risk without realising it. Put simply: At this stage, he doesn’t yet know what can kill him.

STAGE 2: Conscious incompetence or aware and unskilled This stage (and each stage that follows) is often associated with a sensation of awakening or a light bulb being switched on.

he will either give up or acknowledge gaps in knowledge and experience. This acceptance acts as a motivator to learn and practice.

When a diver recognises that he doesn’t know something or hasn’t yet developed a skill to a competent level,

At this stage, the diver hopes and aspires to competency and recognises those who are already competent.

STAGE 3: Conscious competence or aware and skilled At this stage we dedicate ourselves to improving through practice, participation and further training. After completing his initial training, the diver has mastered basic skills, has a good assessment of risk and is able to rescue himself or his buddy. At this

point, he may be the safest diver he can be. He still has a healthy fear of issues, like equipment failure and he’s paying attention. You know you’ve arrived at Stage 3 when you engage in activities that will help you perfect your diving.

Photo by zhu difeng

Stage 4: Unconscious Competence or Unaware and Skilled With regular practice, this stage can be reached relatively quickly. We find ourselves at Stage 4 we no longer have to think about the activity we’re engaged in, we just do it. This stage is akin to a person who’s been driving for a long time making a daily commute. They know the route so well, they hardly remember getting from A to B or anything they saw along the way. For the diver, this is the moment to watch for complacency. As an unconsciously competent person knows what feels right.

Providing nothing has scared them along the way, it’s my feeling that rebreather divers with roughly 50–100 logged hours may be at the greatest risk of becoming complacent and having an accident. If they do have a serious gear malfunction in that timeframe, it can frighten them back to the Conscious Competence level, where they become conscious rebreather divers again. Equally, a long break from diving will also result in a backwards step to refresh our skills before moving forward again.

To avoid the pitfalls of complacency, commit fully to pre-dive checklists. By carefully checking kit and reviewing our preparedness, we’ll be better able to cope with any issues ahead.

Learning a new skill well takes time. But by acknowledging the four stages of competence—in particular the one you are in—you have the potential to become a master.

Photo by Rich Carey

The

ICARUS EFFECT

How Dangerous Psychological Factors Influence Dive Teams by Andy Davis, consultant technical diving instructor at scubatechphilippines.com

Part One Icarus was bold: believing himself invincible, he ignored warnings not to fly too close to the sun and ventured straight into danger. This mentality is one I see crop up in dive teams, so letâ&#x20AC;&#x2122;s explore the psychological factors that influence it. When Dr Guy Garman failed to return to his deep support divers during an open circuit SCUBA depth record attempt in August 2015, I decided to analyse some of the psychological factors affecting dive teams engaging in highcommitment projects. While the tragic world record attempt was a major project, the lessons learned can be

applied to all dive teams: large and small, professional and private, recreational and technical. These psychological pitfalls can influence both individuals and teams to overstretch themselves, venture beyond prudence and risk their safety.

Photo by Gareth Lock

‘While each accident may be different and some of them occur in an instant, most accidents can be represented as a chain of multiple events that lead to deadly outcome. Removing any link from that chain may change the outcome.’

Dr Petar Denoble, DAN Research Director

This first article will explore harmful dynamics that can cause us to dive unsafely.

understand reputation’s role

Diving projects are often underpinned by a degree of reputation-building. For major undertakings this can be necessary in order to secure the funding and brand support critical to making it happen. For other projects, the motivation may be esteem among peers. However, for both individuals and teams, the desire to build or protect a reputation also holds the potential to lead divers into bad decision-making. It’s crucial that teams scrutinise their motives— especially when physical risks are high. What starts out as publicity-building to attract support can easily lead to ego-driven decisions. This forms a psychological constraint that deters the team from aborting, amending or postponing the plan: fear of embarrassment or damaged reputation. If a team has secured funding and support from sponsors, fear of failure can be significant. It’s not unusual for divers to feel concern, real or imagined, that failure to complete could lead to missed support for future efforts. None of us wants to let ourselves or our team down. The team may also be counting on a successful completion leading to publicity or profit for their group. For instance, a technical diving instructor or school associated with setting a world depth record could enjoy a significant

boost in prestige and student bookings. Smaller-scale projects may serve to promote a group or individual among peers; the diving community is not exempt from our sociological attraction to the cult of personality! Whatever combination of motivations, we must not get drawn into the narrative that a project failure puts reputation at stake. This will skew the risk–reward balance that defines the value of a project, and therefore the risk assessments resulting from it. Professional, credible teams pride themselves and their reputation on the safety of their decision-making. That in itself is a measure of esteem. A capable team knows better than to bite off more than it can chew; it sets reasonable and achievable goals along realistic timescales and with appropriate expectations of support. When factors change those parameters, the team does not hesitate in changing the project’s scope to prioritise safety. In short: putting safety first should never result in a loss of prestige.

be careful not to promote dangerous diving Glorifying dangerous dives by making penetration, distance or depth acquisition a goal alone can be a major pitfall for divers. This applies whether chasing world records, pushing a cave exploration too far, fasttracking through technical dive training or pushing the limits of recreational diving. Rewarding dangerous dives with admission into club, clique, or status can all too easily become a form of peer pressure.

Photo by Gareth Lock

Understanding and avoiding known psychological factors is one way to break that first link and prevent an accident.

'Putting safety first should never result in a loss of prestige.'

Photo by Gareth Lock Fixation on depth and penetration can stem from many sources: simple bravado, personal challenge, competitionâ&#x20AC;&#x201D;or from big personalities and limited diving opportunities combining to foster a culture of dangerous diving in a geographical region. Although this is true for both recreational and technical diving, it is particularly apparent in tech. When technical dives can only be conducted on deep ocean walls, with no other specific target or goal beyond depth itself, the only selling point for dive schools or instructors becomes presenting depth acquisition as something students should aspire to. Dangerous diving should never be glorified for popularity or profit. Setting personal records, exceeding penetration comfort zones, and performing deep bounce dives for either of these motivations is not compatible with a positive dive mentality.

Manage overconfidence and ego

Natural capability aside, ambitious diving projects demand significant and sufficient experience. An overestimation of individual or

team competency can lead to a chain of poor decisions resulting in catastrophic accidents. While training and qualifications bring the basics necessary for diving at appropriate levels, the real learning begins when training is completed. Donâ&#x20AC;&#x2122;t assess your personal or team competency based on the accumulation of certification cardsâ&#x20AC;&#x201D;base it on actual performance in the water. In order to progress limits and boundaries when planning an ambitious dive, a healthy dose of self-discipline is needed with a measure of patience and humility. Competency needs to be proven at each level before progression to subsequent ones. Because the only valid proof of competency is through accumulated experience, a diver must have had the chance to encounter and overcome a full range of real problems in which they are able to demonstrate a genuine ability to deal with issues they may encounter. As the scope of diving becomes more challenging, multiple dives at progressive, staged levels of risk are necessary to validate an individual's true competency. With depth, this progressive approach allows the diver to assess their physiological susceptibility and ability to function when exposed to things like inert-gas narcosis, High Pressure Neurological Syndrome (HPNS) and Compression Arthralgia. Only once

Photo by Gareth Lock

Putting dangerous diving on a pedestal contradicts supporting a conservative and progressive approach to developing personal diving limits with patience, humility, caution and self-awareness.

Another factor influencing self-assessment of competency is that of peer groups. It’s important that a divers accurately align themselves with team members at the same level. If an individual is isolated (geographically or dogmatically) from their wider peer group, a distorted perception of equality or superiority can arise. This can contribute to a flawed assessment of capability and competency and can lead them to dive at inappropriate levels of risk. When pursuing personal or team development, it is imperative to remain humble: ego kills divers. It is critical to surround yourself with peers who help you maintain a grounded approach. Divers are often advised to slowly progress their comfort zones. However, it must also be remembered that comfort is not the same as competency. It’s easy to feel comfortable or confident when diving at any given level, but perception of capability can easily be skewed. If nothing goes wrong on a dive that didn’t challenge a person’s abilities, it can’t be considered a true test of competency. Individual diver and team ego must be controlled when it comes to receiving external feedback and advice. Collective wisdom, along with shared community and peer experience, is a valuable thing. But know the difference between genuine assessment from learned peers and negative comment from naysayers. Few people have the desire to break world records or undertake groundbreaking underwater projects but when they do, we must accept that ego is a factor for those who seek to achieve great things. This can be both positive and negative. It motivates when balanced with prudence and wise counsel but it can lead to flawed or fatal decision-making if allowed to go unchecked.

This classic adage holds true: ‘There are old divers, and there are bold divers.

But there are no old, bold divers’. Divers can gain qualifications and theoretical knowledge, and can be encouraged to have a can-do attitude, but they must still seek sufficient experience to gain real wisdom.

balance team motivational support and encouragement

Extreme divers rely upon their support teams to provide logistics, expertise, finance, publicity, sponsorship, and (of course) support—both practical and psychological—that enable diving projects to happen. Positive thinking and motivation are key aspects in that support. However, it’s also the responsibility of the wider team to help keep the primary members grounded and realistic. They should challenge egos and presumptions and not promote them. Dive teams should never be formed of yes-men, sycophants or cheerleaders. Those who aspire to do extraordinary things rarely suffer from a deficit of personal motivation or self-belief. The last thing they need is artificial stimulation of their ego. The team must cautiously guard against insularity; it’s essential to ask for advice, counsel and consultation from outside the team. They should be transparent with their peer group and the wider diving community about their plans. Most importantly, successful teams guard against tunnel vision by respecting and considering external advice offered by peers. Surround yourself with the right people when you need to stay grounded, humble and patient. Align yourself with those who challenge your ego and veer away from those who flatter it. Seek to be a small fish in an ever-bigger pond and reject the temptation to remain the biggest fish in a small pond. It’s tempting to support others in their dreams, whatever the reality. But in challenging dive projects, this desire to be positive can sometimes serve to influence poor decisionmaking or the setting of unrealistic targets. Baseless positivity is not suitable for those

Photo by Gareth Lock

physiological effect is fully known at one level should more complex levels be attempted. Bounce dives or single attempts do not fully satisfy these criteria.

'Ego is a factor for those who seek to achieve great things'

Photo by Gareth Lock working towards unforgiving diving projects. When the consequence of failure could be fatal, it’s more important to be forthright than flattering.

uncertainty of their capabilities—the high-fives and hot air need to end when we move beyond the safe surrounds of low-risk, (somewhat) forgiving, recreational diving.

Don’t believe the hype—especially when it can take a life.

If a diver doesn’t feel humbled during his advanced or technical training then his instructor hasn’t done his job.

Technical and cave diving are becoming increasingly mainstream as access to training, qualifications and equipment becomes more available. With dive centres under pressure to sell more courses and equipment, an increasing number of advanced-level instructors seem unfazed providing instant gratification with the swipe of a card, regardless of the potential consequences. What’s happened to learning and honouring our limitations? Why do we no longer see patience, perseverance, and dedication as vital steps in achieving our goals? When did we stop saying no; or at least, not yet? Accomplishing our dreams requires an investment of time and effort beyond the more clearly apparent need for financial investment. Advanced, technical or overhead environment training is a proving ground. A good technical instructor will leave their students with no

avoid dangerous team dynamics

All dive teams embarking on a challenging project should heed the risks of succumbing to negative team dynamics. They must instigate a process of checks and balances to prevent ego, overconfidence, reputation or a lust for danger from leading them into perilous situations. Be aware that our reputation is not only defined by what we achieve, but also by how we achieve it. Apply the proper protocols and procedures diligently. Maintain an unrelenting focus on safety as a primary objective. If your goal cannot be achieved with a reasonable expectation of safety, then earn respect and reputation by aborting the attempt. Icarus wasn’t invincible and neither are any of us. Dive smart. In Part 2, we’ll take a look at a number of identified psychological phenomena that can lead a dive team into disaster.

Photo by Gareth Lock

respect your limitations

Tangled Hoses Boat Propellers

By Matt Smith

It's no secret that welding underwater comes with many risks and dangers. Many welder-divers leave this field of work forever-changed, some in wheelchairs and some with chronic headaches or aching limbs. Still others â&#x20AC;&#x201D; one lawyer's website claims 13â&#x20AC;&#x201C;17% â&#x20AC;&#x201D; don't make it out at all. Matt Smith, founder of waterwelders.com gets to the nuts and bolts of it.

Photo by Ciro A

Commercial Diver Cause of Death

('89-'97)

70% 60% 50% 40% 30%

Drowning asphyxia Embolism Other

20% 10% 0% It's no secret that welding underwater comes with many risks and dangers. Many welder-divers leave this field of work forever changed, some in wheelchairs and some with chronic headaches or aching limbs. Still others (one lawyer's website claims 13–17%) don't make it out at all. Having researched the death rate among underwater welders I’ve discovered that very little quantifiable information exists, but I felt sure the 13-17% figure must be grossly overestimated.

The following true stories illustrate the dangers of the commercial diving and underwater welding industry.

1989–1997 commercial diver death rate

radio down, out of air at 38m

The graph [above] breaks this down into cause of death.

Years later, Gordon joined Midco Diving and Marine Services to work as a commercial diver — an adventurous job with new challenges every day.

Published data from The Center for Disease Control and Prevention (CDC) on commercial diver death rates from 1989 to 1997 concluded a rate of five deaths per year or 180/100,000 divers. As only around 3000 full-time commercial divers work in the field at any one time, five deaths per year is the most accurate assessment they could find.

When this study was conducted, it blew other figures out of the water, revealing the death rate for commercial divers to be a staggering 40 times that of the national average for all workers. These numbers are the most accurate available, though I'm assuming death rates have decreased significantly as new safety regulations have been implemented.

Safety will always be the number one priority in the commercial diving and underwater welding profession. Many companies conduct thousands of underwater welding operations every year without incident because they remember that the safety of the diver is more important than profit, shortcuts or cost savings.

Joseph Patrick Gordon possessed natural athletic talent and was a star in both football and wrestling at Stillwater Area High School in 1997. After graduating and joining the U.S. Marine Corps, he continued his wrestling, working hard to become a leader of his class.

On October 19, Gordon was working on his pet project: installing pipe material 38m below the surface of Lake Sakakawea. With more depth comes more risk, but Gordon knew the possibilities and had trained diligently.

'Safety will always be the number one priority in the commercial diving and underwater welding profession'

Photo by Ciro A

As a safety precaution, underwater welders are almost always connected to lines going up to the surface where they are monitored. These lines are nicknamed umbilicals and a tug system, where numbers of ‘tugs’ on the lines are signal appropriate surface support, is employed. In addition, surface control is in constant verbal communication with the welder-diver through radio. Gordon started his work deep below the waves but soon noticed that his communication equipment had cut out, leaving him no way of speaking to those on the surface. He had limited air and, to add to the desperate situation, his lines and equipment were becoming increasingly tangled and knotted, disorienting him and causing him to lose his sense of balance.

Working as part of the dive team, John used surface supplied air while drilling and clearing away debris from concrete holes. Several hours pass by with no problems, but 15 minutes into the second hour his air cut out. He switched to his emergency bailout bottle and tried to communicate with surface support. No reply. After some time, John felt tension on his surface line and realised he was being pulled, quickly, to the surface and toward a menacing, rotating shadow. John says it best:

Knowing he only had a short time, Gordon tugged repeatedly on his tangled lines, signaling to the surface that he was in a precarious situation. His colleague swam down and tried to help, but wasn't able to untangle the mass of lines — there was too much chaos in the dark water.

"As I get closer, I remember saying to myself, ‘this is going to hurt a bit before it kills me’. When I get pulled right up to the prop, I start pushing against the cone nut and the umbilical wraps around my right hand between my thumb and forefinger — and then around my right arm.

Unfortunately, because of his depth and lack of air, they were unable to get to him in time.

I remember thinking that my right arm was about to be twisted off like a chicken wing. I reacted by sliding my left hand along the cone nut into the prop to grab a blade. It bounced off a couple of times before I got a grip on it, letting it pull me into the prop so my arm didn’t get pulled off. I remember my bronze Miller clanging against it as I was twisted and twisted. I remember my legs being banged into something very hard that hurt like hell. Then there was a snap and I was out cold."

Tragically, Gordon drowned.

diving knot

The underwater welder in this video has his umbilicals tied to a five-ton concrete block preventing him from surfacing in a timely manner. If he doesn't surface soon, he'll be at risk of contracting decompression sickness: https://www.youtube.com/ watch?list=PL6BBD44629BBEE5B0&v=fzYR0nNX35g

Pulled into the propeller with no way out

John BJ Koch had a marine background and his connections served him well, providing him with a commercial diving job for military contractors. As an experienced welder-diver, his projects took him many places for inspection, burning and welding. The 32nd Naval Base off the coast of San Diego is a beautiful sight to behold, especially on a clear, sunny morning. Though it is kept in excellent condition, the Navy needed new plastic sheet pile facings on

all of the piers across the base. They picked Koch's company for the job and John worked on replacing each of the facings for nine months with his team.

John managed to cut his weight belt with a knife and float to the surface. He survived, but not without extensive injuries to his jaw, shoulders, wrists, fingers, elbows, ankles and back. He's undergone multiple surgeries and had a prosthetic joint put in near his right thumb.

success in safety

As one diver puts it, "Each day our team comes back to the surface without injury, we consider that a success". I couldn't agree more. There’s no question that underwater welding and commercial diving is dangerous work but many people do it safely and end each day with more experience, along with renewed appreciation for their team members.

'As a safety precaution, underwater welders are almost always connected to lines going up to the surface where they are monitored'

Photo by frantisekhojdysz

THE

TITAN TRIGGERFISH: A Tropical Dive Guide’s Nemesis

by Yvonne Tatchley

by her group of newly qualified divers. She’s alert, looking everywhere at once, anxiously thinking, “Where is it? Where is it going to come from?” As the group move alongside the wreck at the bow, she peers around the other side. It’s there! A large, protruding eye stares back, the dorsal-side trigger standing to attention, just visible white teeth, gleam. Startled, her immediate thoughts aren’t reproducible here. She quickly leans back, points her fins toward it and swims away at a rate of knots, trying desperately not to alarm the group and cause mass panic. But it’s too late. Charging at speed, it attacks the first thing in its way... 52

Photo by Rich Carey

The guide descends, closely followed

Issue 6 | November 2015

The scenario above won’t be unfamiliar to any seasoned tropical dive guide or instructor and I would hedge my bets that not one would struggle to guess what marine organism it refers to. It is, of course, the Titan triggerfish Balistoides viridescens. On this occasion, I was lucky to escape with just a hole in my fin, albeit one of many. But the Titan triggerfish has been implicated in more serious injuries on unsuspecting divers. So, what do we know about this apparently aggressive animal? The Titan triggerfish is found predominantly in the Indo-Pacific region of the tropics, in lagoons and around coral reefs, up to a depth of 50m. Colourful and with large, bulbous eyes near the top of its head, this second largest species of triggerfish can grow to 75cm in length and are extremely muscular. They have a small but extremely strong jaw with two rows of teeth, designed to feed on hard foodstuffs such as coral, shellfish, echinoderms and crabs. In place of a dorsal fin, triggerfish have three spines, the first of which can be locked into place by depressing the second spine, hence the name ‘trigger.’ It is believed that the function of the locked spine is to wedge the fish into hiding spots when retreating from predators. There is some debate over whether it also serves as a deterrent in situations of danger. In my experience, the trigger is often raised when divers approach, and I’d agree that it may well function as a warning to predators to stay away.

For the most part, attacks on divers are the result of swimming into the triggerfish’s territory. The fish is simply acting in a defensive and protective manner over her nest, a natural reaction. This situation can be exacerbated by an uninformed diver swimming upwards in panic. Because they remain in the Trigger’s territory, they are more likely to be chased all the way to the surface so it is best practice to swim away horizontally. Unfortunately, there are irresponsible divers out there who find this reaction amusing and purposefully antagonise the fish. This causes Triggerfish to associate divers with nuisance and danger, and results in more frequent attacks. By and large, a Triggerfish attack is not particularly serious. In my experience, it usually results in the diver receiving a collection of holes in their fins. But if the diver is unfortunate enough to get bitten, the fish’s strong jaws can cause lacerations to the skin. Areas most at risk of

Photo Photoby byStephen StephenKerkhofs Kerkhofs

Females nest on the substrate, usually sand, around a coral reef. They are extremely protective of their nests and conical-shaped territory, which extends upwards from nest to surface. If a female triggerfish believes danger is approaching, she will turn side-on to the predator and swim slowly from side to side. This enables her to get the best view possible of her potential attacker. At this point it is likely that her trigger will be raised. Depending on the distance between them, she may swim rapidly and intently toward the perceived threat as a warning before turning back to the nest. But if the danger is close, it’s highly unlikely she’ll turn back and will instead bite the first thing in her way.

Issue 6 | November 2015

Photo by Rich Carey damage will be any protrusions such as fingers, where there is the possibility of fracture. After biting, Triggerfish have been known to suck on areas of soft tissue, which will often cause significant swelling and bruising. In these circumstances they may need to be fought off. Perhaps of more concern than a bite is the panic that results from being attacked. There is a danger that an inexperienced or frightened diver may do anything to try and get away, including rapid ascent to the surface, resulting in DCS or lung overexpansion injuries. Any injuries sustained should be dealt with according to diver first aid training and best practice. If applicable, care should be taken to monitor the diver for any signs or symptoms of DCI and a hyperbaric facility consulted if there are any concerns. If the wound requires suturing, EMS (Emergency Medical Services) help should be sought.

Following a bite, infection in the wound is also a possibility. There have been reports of victims contracting ciguatera poisoning — a toxin produced by tiny organisms called dinoflagellates, which sticks to corals and seaweeds and is ingested by animals that feed on them. Poisoning in humans is usually associated with ingesting fish, but it seems it’s also possible to be affected through bites. The toxin affects the gastrointestinal tract and nervous system causing symptoms such as vomiting, diarrhoea, headaches, vertigo and hallucinations. There is no cure, but the patient will require plenty of care, and treatment for individual symptoms such as dehydration. My advice with respect to Titan triggerfish is to show them respect. If you can’t steer completely clear, always give the animals as much space as you can, swimming away horizontally, not vertically. If one does charge, lean back, point your fins toward it and swim like a bat out of hell!

MUGGED IN MENJANGAN: A triggerfish encounter

Menjangan in Bali is known for its stunning drop-offs, huge variety of sponges, corals and colourful fishâ&#x20AC;&#x201D; including our subject: the triggerfish. Known to be extremely territorial, the triggerfish has a reputation among divers for the aggressive way it defends its nest from intruders. Experienced divers know to keep their distance, but itâ&#x20AC;&#x2122;s not always possible to avoid an ambush. 58

Photo by Nudi Burn www.nudilover.com

by Anke Fabian

Photo by Yellowmargin triggerfish (Balistidae), Abu Dabbab-LauraD shutterstock

Issue 6 | November 2015

'On constant alert, these fish patrol both their horizontal and vertical boundaries and are particularly vigilant during nesting time'

While enjoying a leisurely dive on one of Menjanganâ&#x20AC;&#x2122;s spectacular reefs, Michael Haas and his buddy quickly spotted a triggerfish hanging around the dive site. This particular individual was quite small at approximately 35cm in length and, although it displayed the usual belligerent trigger behaviour, both divers felt comfortable sharing the site with their cantankerous little companion. The trigger was in a typical head-down position near the seabed, an instant alert for knowledgeable divers to keep an eye on it. Triggerfish territories are shaped like upside-down cones and reach from the seabed toward the surface. On constant alert, these fish patrol both their horizontal and vertical boundaries and are particularly vigilant during nesting time, when they chase unwanted visitors all the way to the surface while trying to dig their strong teeth in anything they can get hold of. Knowing this, Michael kept a close eye on the triggerfish from 10m away while also checking on his buddy, who was busy exploring another part of the reef, around 2m away.

Instinctively, Michael raised his arms in defence just in time to stop the second charge. Undeterred, the tenacious trigger banged right into him. He tried to punch the fish away and, following good practice, immediately placed his fins between himself and his tormentor. The trigger swam away to regroup from a distance. Breathing hard, Michael took a moment to check on his buddy. It seemed incredible that his companion, engrossed in exploring the reef about 5m away, was completely unaware of the battle taking place behind her.

Photo by Rich Carey Photo by Laura D

Though his focus was distracted for only a few seconds, it was all the triggerfish needed to launch a surprise attack. Without warning, it struck and Michael felt a sharp pain on the side of his head like a hard punch. Confused, he snapped his head round and soon realised that his assailant was indeed the small (but feisty!) triggerfish. Before he had a chance to move away, the trigger shot toward him again as though to say: â&#x20AC;&#x2DC;Get out and stay outâ&#x20AC;&#x2122;.

Issue 6 | November 2015

'Propelling forward with his back and tail fin, he rushed the pair one last time'

Suddenly, the trigger darted towards her. Moving quickly, Michael positioned himself between unsuspecting buddy and irate fish, again placing his fins in the line of fire. Remarkably, his buddy remained totally oblivious of the danger and continued to swim calmly and peacefully over the reef! By now Michael’s head was throbbing, with the pain centring around an area just a few centimetres above his ear. Touching it with his fingers, he felt a large bump with an open gap in the middle. It was definitely time to leave. Getting his buddy’s attention, Michael signalled to abort the dive. Unfortunately, their only route back cut right through trigger country. Unable to avoid the underwater Rambo’s territory, Michael swam on the outside of the reef to protect his buddy from any further trouble. But the triggerfish was undeterred. Propelling forward with his back and tail fin, he rushed the pair one last time.

Back onboard, Michael’s buddy, a trained nurse, could not believe she’d missed the entire incident and was only too happy to be able to help her injured friend. Beginning by shaving the area around the cut, she then inspected for foreign bodies, rinsed thoroughly with drinking water, disinfected and bandaged the wound with a plaster. Happily, Michael’s injuries healed without complication, but he will never forget the day he was mugged in Menjangan! michael haas : http://www.amazon.de/michael-haas/e/b00dZfL3v2

Photo by Rich Carey Photo by Rich Carey

In past encounters, Michael had found this swim-style amusing, but today he wasn’t laughing. Pointing to the triggerfish, Michael grabbed his buddy by the hand and moved away as fast as possible from the danger zone.

Issue 6 | November 2015

Case study: Single Cylinder Entanglement â&#x20AC;&#x201D;by Gareth Lock

This monthâ&#x20AC;&#x2122;s case study concerns a diver with a safe attitude who, through peer-pressure and desire to please their instructor, found themselves in a very dangerous situation. She was lucky to escape with her life. Unfortunately, for all those reported, I am sure there are many examples of similar situations that go unreported because those involved feel guilty for not having the assertiveness to speak up, despite having found themselves in the circumstances due to pressure from someone else. 64

Photo by Gareth Lock

Issue 6 | November 2015

the bacK-story Diver 1 (the subject) A qualified AOW (Advanced Open Water) diver who had been diving for approximately six months. The instructor had taught Diver 1 and had regularly boosted her confidence during training by telling her she was an excellent diver. Diver 1 soon started to help in pool classes as a ‘safety diver’ for the instructor. Although Diver 1 appreciated the trust, she was far from feeling excellent, recognising her lack of experience. Diver 1 soon had questions which the instructor was unable to answer and started to see mistakes in the training, doubting some of the decisions being made. On the dive in question, there were five new divers and the instructor as a guide. The instructor had recently certified the four others as open water divers and Diver 1 had disagreed that three of them were ready for certification. diver 2 A stressed diver, before and after dives. She had not yet understood trim, so maintained a vertical position in the water, and she was too nervous to descend without holding the instructor’s hand. diver 3 A distracted diver, easily forgetting pieces of equipment and how much weight they needed use. Buoyancy control hadn’t yet been developed and they were unable to clear their mask. diver 4 An adrenaline-junkie diver. Showed little empathy or consideration for others and was often in some kind of trouble. Equally oblivious to their fins in relation to the environment. diver 5 An overly confident new diver, verging on arrogant. The instructor dived with them to give them experience. Diver 1 used to go on the same boat with them and was sometimes frustrated to be included in the instructor’s dive plans without being asked. Even more so, because many of these dives were beyond 18m—their certification limit.

Photo by Andrea Izzotti

Issue 6 | November 2015

the incident The instructor took these four divers to a dive spot that was 27m deep and, because the visibility seemed very bad, again included Diver 1 in the group without prior-warning. He said that everybody should follow him and Diver 1 would bring up the rear. He then spoke privately with Diver 1, saying: ‘Please, don’t lose anyone!’. Diver 1 noted his nervous tone and that this was very unusual. Diver 1 was irritated, but followed the group and did her best. Diver 5 was often changing depth and moving away from the group—this, combined with the poor visibility, meant that she soon became more stressed. At some point, Diver 5 suddenly ascended to 10m and Diver 1 went after him. After helping him descend again, Diver 1 pointed to where the others were. Diver 5 moved, but hit Diver 1 on the head, which threw her against a rock. Feeling dizzy, Diver 1 tried to follow Diver 5 but realised she couldn’t move and watched Diver 5 disappear in the poor visibility without looking back. Diver 1 was now trapped in a ball of fishing lines at 27m. She looked at her SPG and realised she only had 60 bar left. Having trouble getting out of the line, getting increasingly nervous, and watching her air pressure drop, she cut her hand. When she finally got loose, she had very little air. Attempting a slow and steady ascent, she ran out. She recalls feeling very dizzy and afraid of fainting. As she reached the surface the instructor yelled at her, asking what had she been doing. It was only when he saw that she was throwing up and shivering, that he calmed down. The situation was not discussed on the boat, so Diver 1 went back home feeling sick, guilty and confused.

Photo by Gareth Lock

Photo by ????

Issue 6 | November 2015

Photo by Gareth Lock

Issue 6 | November 2015

additionaL information The instructor only found out that Diver 1 was missing when the group reached the shot line. He was then confronted with a dilemma: search for the missing diver or take the other four divers to the surface. Because he didn’t trust them to ascend safely yet, he took them up. On the surface, Diver 5 told the instructor the wrong location of Diver 1 and that she was ‘looking at fish’. Diver 5’s misrepresentation of events is significant in that it led to the instructor descending on his own to search for Diver 1 and going to the wrong location—which could also explain his anger at her when she did surface.

anaLysis There are so many lessons to be learned from this incident but here are five key ones to take away. 1 Peer pressure Diver 1 wanted to please her instructor who had had helped her to develop when she first started to dive and didn’t like it. 2 decision making There were many opportunities to end the dive: from not certifying the divers to not allowing OW divers on sub-18m dives, to having an effective brief or recognising that six divers in poor visibility was going to be challenging. Unfortunately, by the time the six divers were in the water an incident was already on the cards. 3 skills All training agencies have minimum standards which need to be mastered before a certification is issued. Unfortunately, commercial pressures mean that upselling of courses or specialties is sometimes used as a way of filling in gaps from rushed basic training. 4 Positive reinforcement Encouragement has value, but consistently telling someone they are excellent can mean it is hard for divers to recognise their own shortcomings and mitigate accordingly. This phenomenon is well-documented as the Dunning– Kruger effect in a study from Cornell University. In essence: you don’t know what you don’t know (even if someone is telling you that you do know it!). 5 cutting devices Cutting devices should be considered essential on every dive and must be reachable by either hand. A knife on the calf is not easily accessible in all situations and there have been incidents when a ditched weight belt has snagged on the knife, leading to a fatality. On a final note, if you have been involved in an incident, please consider reporting it to DISMS (Diving Incident Safety Management System, divingincidents.org) with a similar level of detail so that we can all continue to learn. If you want to discuss it beforehand, feel free to drop me a line at gareth.lock@cognitas.org.uk.

What We Have Hereâ&#x20AC;Ś Is A Failure To Communicate! Dan Orr, President Dan Orr Consulting One of the most important issues in diving safety is communication. As part of your preparation for diving, you and your diving partners generally spend considerable time and effort putting together a comprehensive dive plan. That plan includes topics such as maximum depth, planned maximum bottom time and how much air you should have when you surface at the end of the dive. Many divers limit their plan to these bare essentials and leave the rest to memory or chance. One area generally neglected is a discussion or review of hand signals used to communicate important information

throughout the dive. Just about everyone, in their entry-level certification course, will be taught standard hand signals including; up, down, okay, air (low and out) and others. We all know these signals well and use them where and when appropriate. A few years ago, I was enjoying a beautiful wall dive when another diver approached my buddy and me in obvious distress. She put both hands to her throat and, thinking she was choking, I grabbed her and quickly helped her to the surface. Once Iâ&#x20AC;&#x2122;d made sure she was buoyant, she spat her regulator out and with a perplexed look said, â&#x20AC;&#x153;What in the

Photo by Dudarev Mikhail

Issue 6 | November 2015

h@##’s wrong with you?” It turned out that the signal, both hands at the throat, was one she and her companions used to signal that they were low on air. Back onboard our dive boat, I asked why they didn’t use the standard clenched fist at the chest. She said that since almost all their diving was done in quarries and other areas of limited visibility, they found it nearly impossible to see a gloved hand against a dark BCD and wetsuit so they began using something they all could recognise. Both hands at the throat seemed to work, until now!

On another series of dives while traveling in the Pacific, I was given three different hand signals by three separate divemasters to use when indicating that we’d reached the point where we should turn the dive because of remaining gas supply. The first, was two fingers pressed against the forearm, the second, a slashing/cutting motion across the forearm and, the last, a two-handed ‘T’ sign like the time-out signal in sports. To be honest, I’d always just pointed to my pressure gauge and made a circular motion with my finger to indicate a turn around.

Photo by Dudarev Mikhail

Issue 6 | November 2015

Let’s face it, even the simplest hand signals can be confusing. How many times have you casually asked your diving partner underwater, “Are you okay?” with the standard ‘O’ signal using your thumb and forefinger only to receive a thumb’s up signal in return?

should review all critical hand signals as part of your comprehensive dive preparation and, to avoid confusion, it is best to use universally accepted and understood signals or spend some time explaining unique or regional variations with your buddies.

The examples here, dramatise the importance of reviewing hand signals prior to any dive. Misunderstanding hand signals or using them for anything other than their intended purpose or meaning can be confusing at best, disastrous at worst. Both you and your dive buddies

As part of this dive preparation, review the entire dive and discuss how you will communicate critical information as the dive progresses. Consider if your dive will have any unique features or defined objectives. If it does, develop dedicated hand signals to enable you to communicate

specific goals or directions to complete the dive successfully. Remember to review those particular signals before each dive and only use them with the group for which they are developed. Discuss in detail when you are likely to pause during the dive to exchange information, such as, “Are you okay?” or “How much air do you have?” and so on. I also believe it’s important to look for opportunities to verify your buddy’s wellbeing. For instance, I like to pause during my initial descent, at about 4.5m below the surface, to ensure that everything’s okay with all the divers in my group and I make

sure they know this is part of the plan. This safety stop on the descent gives us all a chance to make sure we’re alright before continuing the dive. If something’s wrong, we can easily return to the surface to solve the problem before continuing. Of all of the hand signals that you may use, one of the most important is the simple ‘thumbs up’ signal. An absolute I learned during my training as a full cave diver many years ago was that giving the ‘thumbs up’ meant the dive was over, no questions asked. I still strongly believe in the importance of that signal because it means that each

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Issue 6 | November 2015

individual is in control of the dive and shares equal responsibility and ability to call the dive at any time, including before the dive begins. It’s crucial that all members of a dive group decide this as part of their dive preparation. It should also be agreed by everyone that, should an individual no longer feel they can continue, all they have to do is raise their thumb and the dive is over. As an aside, if you’re a buddy of someone who calls the dive, you should accompany them back to the boat or to the shore making sure they are safely out of the water before trying to locate another buddy to continue

the dive. The same goes for a threesome; both buddies accompany the one who called the dive back to the exit point. There are many cases where divers said goodbye to their buddies who called the dive never to see them again. Knowing how to effectively communicate underwater is a critical skill and one that must be discussed and reviewed with your buddy as part of your preparation before every dive. You can’t leave something as critical as communicating to either memory or chance, hoping you’ll be understood when it comes to the crunch.

THE ISSUE OF

EQUALISATION

& ASCENT By Andrea Zaferes

The first skill new divers learn when descending more than 1m is how to equalise. Without equalisation, the ear drum can be damaged, so we’re taught at least one of several techniques including jaw-wiggling, swallowing, head tilt and, most commonly, the Valsalva manoeuvre, to release pressure. If you’ve ever felt pressure or pain in your ears while descending to the bottom of a pool, you’ve experienced ear squeeze. This happens when water pressure causes the volume of air in your middle ear to decrease (for more info, read-up on Boyle’s Law). Equalising allows more air to enter the airspace in our ears, releasing the pressure and relieving the pain. The Valsalva manoeuvre is much easier to experience than to explain, so for the uninitiated, let’s give it a try. Put one hand on your chest, gently pinch your nose closed and blow. Did you feel the tension created in your chest? Did you realise that when you inhaled you then held your breath and forced tension on your lungs as you continued to hold it? Yet we are also taught early on that the golden rule of SCUBA is to never hold your breath. But what is a Valsalva manoeuvre if not a breath-hold? The skill of equalisation breaks the rule of breath-holding and creates tension in the lungs.

Use of an equalisation technique that involves holding your breath, like Valsalva, is not a problem as long as you’re stationary or descending at the time. But—and there’s always a but—if we experience ear pain or are having trouble equalising, we’re taught to ascend a metre or so to relieve the discomfort. Because it’s possible to perforate lung tissue with just a 1–1.5m rise while holding a full breath, it’s important for all divers to achieve good buoyancy control while equalising; it’s very easy to rise 2m or more without realising it while struggling to equalise. Divers who are under stress can also be at risk. Taking large breaths can cause a sudden or unexpected rise. And a forceful Valsalva can lead to problems such as round window ruptures, known to cause severe vertigo. Equalisation problems are easily missed as a contributing factor to an LOEI (Lung Over Expansion Injury) incident. One of the consequences of this could be seriously delayed recognition, resulting in treatment delay.

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Case Study setting the scene A 38-year-old inexperienced diver takes a refresher course prior to a dive vacation. She makes five check dives with her class between 9m and 18m on the first day, no difficulties are reported. On day two, she makes three dives: 18m for 28 minutes, followed by a 40 minute surface interval; 9m for 10 minutes, followed by a 50 minute surface interval; and a third dive to 24m, which is her first time diving in a strong current and rough water. the dive During the descent, she has some trouble equalising and makes a brief return to the surface, immediately descending to 25m. Within a few minutes, she begins to feel panicky and lightheaded, thinking her regulator is breathing hard. Signalling to ascend, she heads for the surface. The group follow with a slow ascent and safety stop.

When they surface, she is found floating and unconscious. Onboard, she regains consciousness and complains of a mild headache. She has no real memory of the dive and says she feels as though she canâ&#x20AC;&#x2122;t lift or move her body. Other symptoms include fatigue, chest discomfort and an urge to cough. She goes home to bed. During the next week she suffers from severe headaches, weakness, lethargy even with rest, difficulty reading text from side to side, and a constant tingling sensation in her fingertips. diagnosis This diver was diagnosed with AGE and pulmonary barotrauma with delayed treatment. She couldnâ&#x20AC;&#x2122;t recall if breath-holding occurred during her ascents. Eight days after the incident she called DAN, received treated and made a complete recovery.

Issue 6 | November 2015

Photo by Roy Pedersen

Analysis Two key dive rules were broken, which could have increased her chance of DCS (Decompression Sickness): making more than three entry-level training dives in one day, and making a third dive that was deeper than her previous two dives on day two. However, these factors were unlikely to have contributed to her pulmonary barotrauma and AGE. The case history tells us is that this diver had equalisation difficulties that caused her to ascend. The words ‘brief return to the surface' tell us that she didn’t surface slowly—and that she was likely equalising during the ascent to try and avoid being left behind or aborting the dive. All that diving, combined with the strong currents and the stress of a first deeper dive, meant that there’s a strong chance she was breathing heavily, which would have increased stress on the pulmonary system during the equalisation ascent. Heavy breathing would also

have made her more buoyant—within minutes of this equalisation event, she started having problems. The fact that the problems began at depth means they were severe. The diver’s symptoms and history are classic of pulmonary barotraumas, yet she, her peers, and (worse) her instructor did not recognise them. If those involved were trained and experienced in performing field neurological evaluations, this diver would probably have received immediate treatment rather than an eight-day delay. The diver’s complete recovery was lucky, not all have such good results. Sadly, six months after the incident, she was still hesitant to dive again. There is no doubt that better education could have prevented the incident happening in the first place, and certainly could have prevented the significant delay in treatment.

understanding what help is needed

Itâ&#x20AC;&#x2122;s important to ask divers who seem to have had a problem to describe any equalisation issues that occurred during the dive and what they did to relieve them. If the diver experiences severe vertigo, for example, an ear injury may exist in conjunction with a lung overexpansion injury. And what caused the diver to experience severe equalisation problems? Were they suffering from (or recovering from) congestion, bronchitis, allergies or some other pulmonary factor that increases risk of an overexpansion injury? Again, ask questions of the potential patient in a straightforward, empathetic and nonjudgmental manner. Record the answers as they respond.

Equalisation Assesment for the diver: 1.

Did you experience any equalisation problems during the dive?

Describe them.

At what depth did you notice problems happening?

What did you do to try and resolve them?

What equalisation methods did you try?

Were you holding onto a line while you tried to equalise?

Were you aware of ascending while trying to equalise?

If so, how far did you ascend before you either managed to equalise or aborted the dive?

Did the equalisation problems happen more than once during the dive?

10.

And had they happened on any previous dives?

11.

Why do you think you were you having equalisation problems?

12.

Are you suffering from cold symptoms that could also include lung congestion?

and for dive leaders or fellow divers: 1.

Did you notice if the diver had any equalisation problems?

Give a step-by-step playback of what you saw happening.

Did the diver ascend while attempting to equalise?

Dovenbarger J. (1995) The one-two punch: one diver learns that inexperience, and switching the order of the 'deepest dive first' rule, can pack a double wallop. Alert Diver July/Aug, p 18.

Photo by Amanda Nicholls