Alert Diver Autumn 2012

DIVER

Alert

DAN: Your Dive Safety Association

Autumn 2012, Vol 4 No 1

IGNORING WARNING SIGNS When the nightmare becomes

A REALITY

ISSN 2071-7628

WINTER DIVING IN CAPE TOWN

Evolution of

BREATH-HOLD DIVING

DIVERS ALERT NETWORK

Always ready when it matters MEDICAL

‘‘

Although I never needed DAN’s services, it is comforting to know that they are there in the event of an unwanted mishap!

Andries – DAN member

AlertDIVER www.dansa.org Diver www.dansa.org 2 ALERT

www.dansa.org

CONTENTS MEDICAL

Autumn 2012

24

16 TEAM 6 PROFILE Dr Louis van Heerden DIVE 10

BREATH-HOLD DIVING To apnoea, or not to apnoea? That is the question

STATISTICS 14 DAN-SA HOTLINE Activity report for 2011 15 DISTRIBUTION STATISTICS DAN annual & student membership

MEDICAL 16 HEAD INJURIES 24 BLOOD UP Incident insight MEMBERSHIP 20 WHAT MAKES DAN SPECIAL 30 THE DSP TRAVEL GUIDE Cape Town

26 RESEARCH 38 THE KIDS AS DOLPHINS PROJECT Young breathhold divers

REGULARS 2 MESSAGE FROM FRANCOIS BURMAN 3 MESSAGE FROM DR JACK MEINTJES 4 DAN TEAM 8 LETTERS AND COMMENTS 22 MEDLINE Q&A 42 PRODUCTS 44 RECIPE 44 DR OCTO 46 DAN BUSINESS MEMBER DIRECTORY 49 PARTING SHOT FRONT COVER

TRAINING 26 NUTS & BOLTS for the future 34 A SAFETY CORNERSTONE TURNS 20 DAN’s 45

Oxygen First Aid programme DAN TRAINING & EDUCATION Courses offered

SAFETY 28 WHEN THE NIGHTMARE becomes a reality 36 CHAMBER PROFILE Seychelles

Image by Mark van Coller.

Alert Autumn 2012 ALERT

Diver 1 DIVER

MESSAGE

Awareness, Training & Competence AWARENESS, TRAINING & COMPETENCE FASHION THE CORNERSTONE OF ANY SAFETY PROGRAMME. FROM THE CEO’S DESK Our mission has always focused on our ability to assist divers in need and offering practical and realistic safety in diving. Over the past 15 years, since our inception in early January 1997 up until now, we have been involved in the concept of safety, from post-accident management, research into safer diving practices, and training for preparation in the event of an accident, right through to the pro-active awareness and planning initiative referred to as the HIRA programme.

It is our firm belief that as much as it is important to be able to take care of divers who are injured, we should be expending as much, if not more, energy in trying to prevent accidents from happening in the first place. Of course, one does not want to remove the risks involved in diving completely, lest we reduce it to a mundane, controlled activity. It is that element of uncertainty and the unknown that imparts much of the thrill. We also do not wish to make it so tedious in terms of planning and avoidance of risk elements that divers will lose interest!

However, if we can introduce the right blend of awareness by all, training by those that want to be able to help, and competence in those that serve our industry, we should surely make our diving safer, yet no less enjoyable!

To achieve this requires some degree of lateral thinking: we want to be sure that we focus our research, training, skills development, safety equipment and publications to complement this effort.

‘‘

WE SHOULD BE EXPENDING AS MUCH, IF NOT MORE, ENERGY IN TRYING TO PREVENT ACCIDENTS FROM HAPPENING IN THE FIRST PLACE.

You will have read about the RCAP programme where we are endeavouring to improve the quality, safety and availability of treatment centres around the diving world; you will have noted the new training programmes: first aid course, diving medicine for divers, recreational diving medicine for doctors (which also provides appropriate education for practising dive medicine in remote areas), and the chamber staff and maintenance training courses; you will be witnessing our assistance and guidance in the safe management and operation of our business members who are dive operators – the HIRA programme; and soon you will be reading about our local diving research initiatives and programmes.

We have realised that in order to achieve an acceptable level of safety in diving, we need to start right at the beginning of the cycle: Education of all those involved. DAN Southern Africa is playing a leading role in this endeavour internationally and we are intent on building a culture of awareness and safety through all our activities.

Diving must remain fun, satisfying and exciting, but we can achieve this safely and responsibly, and it is our obligation to work towards this.

Safe diving!

Francois Burman CEO DAN Southern Africa AlertDIVER www.dansa.org Diver www.dansa.org 2 ALERT

MESSAGE

Image by Cormac McCreesh.

FROM THE MEDICAL DIRECTOR’S DESK Another year has flown by and we are facing yet another year, which I certainly hope will be less rushed than last year! I hope all of you enjoyed a good festive season and were able to enjoy fabulous dives at exotic dive sites. To all the members we assisted during the peak season, hopefully you have recovered fully! We will certainly call or email you to follow up on your healing progress.

‘‘

WE WOULD RATHER RECEIVE MORE CALLS FOR LESS SERIOUS CONDITIONS THAN NOT RECEIVE A CALL IN TIME.

serious illness. I hope we can somehow change this approach to symptoms after a dive.

Note also the new addition to our team of medical doctors. We want to assure you that the team is still passionate about assisting divers!

Happy diving!

Dr Jack Meintjes Medical Director DAN Southern Africa

I hope you find this edition of Alert Diver insightful and stimulating. I find the article by Dr Gary Morris particularly important, since we see a number of divers who seem to be quite fit, but nonetheless are unfit for diving. I cannot stress the importance of a diving medical examination enough and (even more so) the importance of reporting signs and symptoms early. Most persons phoning our hotline do not do so because they have symptoms, but rather because the symptoms will not go away. We would rather receive more calls for less serious conditions than not receive a call in time for a condition that presented with minor symptoms initially, but subsequently progressed to a Alert Autumn 2012 ALERT

Diver 3 DIVER

TEAM

The DAN-SA Team

THE DAN HOTLINE IS MANNED 24/7/365

BY OPERATORS AND DOCTORS SPECIALLY TRAINED TO DEAL WITH DIVE EMERGENCIES. THE MEDICAL TEAM DOCTORS ALTERNATE TO BE ON CALL FOR THE DAN-SA HOTLINE.

The Core Team FRANCOIS BURMAN Francois serves as the chief executive officer for DAN-SA. He is currently responsible for the operational, technical, safety, financial and insurance aspects of DAN and its programmes.

He serves as treasurer on the board of International DAN (IDAN) and is also their technical consultant. francois@hydra.org.za

SEL-MARIE PEREIRA Sel-Marie is our DAN membership services administrator. She is responsible for all aspects of membership administration, data capturing and sales. sel.marie@dansa.org

AlertDIVER www.dansa.org Diver www.dansa.org 4 ALERT

MORNÉ CHRISTOU Morné manages special projects and marketing.

He is also our Diving Safety Partners (DSP) Programme co-ordinator. morne@dansa.org

DAWN AVICE DU BUISSON Dawn is responsible for supporting the DAN-SA medical information and emergency hotline during office hours. She works closely with Netcare when further assistance or evacuation is required and provides important quality assurance and customer care related to these calls. danmedic@dansa.org

TONI KRIGEMCQUILLEN Toni serves as our membership services assistant and is responsible for general membership and student membership enquiries. She is also responsible for maintaining the DAN-SA website. toni@dansa.org

TEAM

The Medical Team DR JACK MEINTJES Dr Jack Meintjes has served as the medical director for DAN-SA since 2007. Dr Meintjes has experience in hyperbaric medicine and has vast commercial diving medical knowledge and experience.

DR ISABEL READER Dr Isabel Reader is currently one of the directors of the emergency rooms at Akasia Hospital in Pretoria. She has served as a DAN medical officer since 2006.

DR ROB SCHNEIDER Dr Rob Schneider is a general medical practitioner practising full-time in emergency medicine in Pretoria.

DR HERMIE BRITZ Dr Hermie Britz rejoined the DAN medical team as assistant medical director in 2011 and has vast experience in emergency medicine, PFO screening and offers support for deep technical diving.

DR LOURENS DE KOCK Dr Lourens de Kock is one of the partners in a busy diving, aviation and maritime medical practice in Cape Town.

DR CECILIA ROBERTS Dr Cecilia Roberts has completed her BScMedScHons degrees in underwater medicine and hyperbaric medicine, and currently serves as the medical director for the SUN Baromedical Facility.

DR MIKE MARSHALL Dr Mike Marshall has served as the medical director for the St Augustine’s Hyperbaric Medicine Centre since its inception in 2000 and has been a part-time medical officer at DAN since 2002.

DR GARY MORRIS Dr Gary Morris is a general medical practitioner from Scottburgh, KwaZulu-Natal.

DR LOUIS VAN HEERDEN Dr Louis van Heerden qualified as an open water diver in 1994, and as a medical doctor in 1999. Attaining his BScMedScHons degree in underwater medicine in 2010 allowed him to merge passion and profession. He is currently AD working as a partner in an emergency medicine practice and a hyperbaric oxygen therapy unit at Pretoria East Hospital.

Alert Autumn 2012 ALERT

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TEAM

DMO PROFILE Dr Louis van Heerden

‘‘ LOUIS

van Heerden is 36 years old and qualified as a medical doctor in 1999. Since his earliest memory of the sea he has always had a yearning to discover its mysterious beauty, and in December 1994 he qualified as an open water diver in Sodwana Bay. His favourite destination is anywhere where living coral reefs are found, but he holds a special place in his heart for the Maldives. Other favourite destinations include the Red Sea and Mozambique.

Diving was the start of more than just a hobby. The marriage between profession and passion was quite unexpected, and happened when he attained his BScMedScHons degree in underwater medicine in 2010 at the University of Stellenbosch. He was first introduced to hyperbaric medicine in 2005 by Dr Frans Cronjé and the close relationship with dive medicine made him explore it further.

Louis feels strongly about all aspects of dive safety and that recreational AlertDIVER www.dansa.org Diver www.dansa.org 6 ALERT

LOUIS’ PHILOSOPHY IS TO EMPOWER THE DIVER WITH KNOWLEDGE THAT WOULD ALLOW HIM OR HER TO BE AN AMBASSADOR OF THE SEA FIRST AND FOREMOST, BUT ALSO AN AGENT OF SAFETY AND CONSERVATION.

divers should be educated properly to enable them to enjoy diving responsibly.

Very few people realise that the sea is not an unlimited resource. An attitude of conservation and respect for the sea should be cultivated hand-in-hand with dive safety. Louis’ philosophy when it comes to this is to empower the diver with knowledge that would allow him or her to be an ambassador of the sea first and foremost, but also an agent of safety and conservation. It is with this in mind that any diver should be encouraged to become a DAN member.

Louis has joined DAN as a diving member before, but has also recently become a DMO (dive medical officer) with the organisation.

When Louis was asked why he is a DAN member his answer was direct and to the point. He simply said, “To lend my support to DAN’s mission of providing medical emergency assistance”.

Louis is currently working as a partner in an emergency medicine practice and a hyperbaric oxygen therapy unit at Pretoria East Hospital. AD

When you need it most

TEAM

24-Hour Emergency Hotline Medical Advice Help in Diving Emergencies Specialised Diving Physician Referrals Access to Evacuation in a Medical Emergency

www.dansa.org Alert Autumn 2012 ALERT

Diver 7 DIVER

LETTERS

DAN Letters

& Comments

How did DAN help you?

Send us your stories via email or our blog

alertdiversa@dansa.org • www.dansa.org

DIVE FOR LIFE

At the Jakaranda (established in 1986) and Louis Botha (established in 1918) children’s homes we strive to dismiss the developmental hindrances that the children we care for have experienced, introduce them to a wide range of opportunities, develop their skills and aid them in reaching their full potential, and teach them to act as responsible adults when they leave their homes.

Dive for Life is a PADI-certified educational facility that aims to develop the skills and self-esteem of selected learners. A key objective of the programme is Project AWARE, which focuses on education, advocacy and action in its efforts to preserve and raise awareness about the importance of aquatic conservation. Through the Dive for Life project and further training this will create employment opportunities for the children.

Through sponsorship and in association with Blue Reef Divers we were able to take the children to Mozambique (Parque de Malongane) to complete

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their qualifying dives in the ocean. Diving at 11 m for 21 minutes, one of the children suffered an arterial gas embolism upon ascent. The dive was immediately aborted and the child was given oxygen. Luckily for us, a qualified DAN doctor was on the beach and assisted us.

From Malongane, the child was rushed to Manguzi Hospital and received stabilising treatment before taking the ambulance drive, organised through DAN, to St Augustine’s Hospital in Durban, where the child went to the hyperbaric chamber for recompression therapy. The service provided throughout was impeccable. This was a very stressful time, but thankfully DAN was there supporting us all the way. Not only were the DAN staff members professional and polite, but they were caring and efficient too.

I shudder to think what would have happened if DAN had not been there to help and guide us. Even when one staff member (who was initially involved in the case) was going off duty I would be informed of who my contact person would be from then on. The child was on the DAN student package and DAN covered all the medical expenses in full!

By God’s grace the child made a 100% recovery and DAN still called some days after the incident to enquire how the child was. The child participates in cycling now (and in cycling competitions on weekends) and is doing very well!

I can’t express in words just how grateful I am. I have always believed that a medical aid and DAN are important to have, but after going through this experience it showed me just how vital they are!

Charlene Grobler Social worker/Project manager of Dive for Life

LIVE-ABOARD INCIDENT

I was part of a diving group that was diving from 24-30 August 2008 in the Red Sea and was staying on board the HYATT live-aboard boat. After finishing my orientation dive and while showering in my cabin I slipped on the novilon

LETTERS

tiles of the shower floor (due to the roll of the boat) and hit my back against the toilet basin. This resulted in a severe pain in my lower ribcage. Medical doctors who were part of our group examined me and presented me with a choice: take the available pain medication but NO diving, or dive with the pain.

I am not the “macho” type, but having saved over a lengthy period for diving in the Red Sea, it was a simple choice to make.

It was only when we were back in Cairo on 1 September 2008, and after phoning DAN in Johannesburg, that Dr Morris requested I rather consult a doctor in Cairo and also have X-rays taken. This was done at the Hayat Medical Centre in Cairo. Results: two broken ribs (ninth and tenth).

I again phoned DAN in Johannesburg and informed Dr Morris of the outcome of the consultation with the doctor in Cairo who also confirmed that I was able to fly back to South Africa.

Due to severe pain I was forced to upgrade my flight from Cairo to Johannesburg from economy class to business class. Expenses paid by me in Cairo as the result of my injury totalled an amount of nearly R3 400.

Upon my arrival back home, and after being advised by the personnel of DAN Southern Africa, all my expenses were paid back to me by DAN. My sincere thanks to Dr Morris, Helia, Dawn, Lana and Phillip for their professional service, expert advice and concern for my well-being. I would also like to thank Hennie Langeveld for organising the memorable tour to Sharmel-Shaik (Buddy, the pain of the broken ribs will soon be gone but I will never forget the beauty of the Red Sea!).

Needless to say, everyone in the diving environment should seriously consider joining DAN before they undertake any diving adventure.

Anton Uys

FAR FROM HOME

On 6 October 2011 my husband and I were diving in Paindane Bay, Mozambique. We were busy launching the boat when a wave knocked me over and I landed underneath the boat. I was pinned between the boat and the sand. The next wave lifted the boat and it moved away from me. Immediately we realised we were in a lot of trouble being so far from our home in South Africa and also the consequences we had to face to get me to the nearest hospital and emergency room. My husband phoned DAN and a lady by the name of Dawn assisted him. After half an hour the diving charter transported me to Inhambane and X-rays confirmed that I fractured my left pelvis bone and left hip bone. Dawn and the DAN doctor phoned my husband by the hour to confirm how I was doing. DAN airlifted me the next morning with a jet (Rescue 911) plane from Inhambane and they brought me back to South Africa.

A trauma doctor was on board and stabilised me before I was airlifted. DAN also arranged an ambulance to take me from Lanseria Airport to the Little Company of Mary Hospital where a doctor was awaiting my arrival. I was then booked into the ICU. DAN and staff, you were fantastic! Thank you for your assistance during this unfortunate accident and getting me back home where I could get the best treatment possible. Without your help, all of the above would not have been possible. You have a great team on board!

DAN EVENTS FOR 2012 RESEARCH DAYS

We invite all divers to participate in our lung function study. Also, divers who experience ear problems before or after a dive are welcome to visit the DAN research station and ask the DAN doctor to inspect their ears (using a video otoscope).

We encourage all divers to participate in our international dive data collection research project: DAN Project Dive Exploration. Diver profiles will allow the DAN doctors to better understand problems divers experience in different diving environments.

3 March: Miracle Waters (Gauteng) 28 April: Miracle Waters (Gauteng) 24 November: Miracle Waters (Gauteng) 9 August: Simon’s Town (Western Cape)

DAN TRAINING WORKSHOPS

We invite all DAN instructors to join the DAN training workshop where we plan on launching the new DAN First Aid and BLS courses.

As part of the workshop we will offer a DEMP instructor refresher course with a presentation on how best to market DAN courses.

13-15 April: DAN Office (Gauteng) 17-19 April: Cape Town (venue to be confirmed)

PORT ELIZABETH DIVE FESTIVAL – JUNE

We will be attending the PE Dive Fest in 2012 and plan on continuing our efforts to promote dive safety, as well as offering divers the opportunity to participate in our data collection research projects.

DAN DAY AT SIMON’S TOWN NAVAL BASE – AUGUST Please refer to the website for further details.

HAZARD IDENTIFICATION & RISK ASSESSMENT (HIRA) PROGRAMME

Our goal for 2012 is to officially launch the HIRA programme in the DAN Southern Africa region. During the course of the year we will be visiting dive charters in the Western Cape, Gauteng, KwaZulu-Natal, Mozambique and possibly Mauritius to perform assessments, and in so doing help improve the safety of scuba diving.

Mrs E.A. du Toit (a proud DAN member) Alert Autumn 2012 ALERT

Diver 9 DIVER

DIVE

Breath-Hold Diving Part 1

By Dr Rob Schneider

To apnoea, or not to apnoea?

That is the question Freediver Sophia van Coller practising two days before her attempt to break the South African women’s record in the Dynamic with Fins discipline.

She will attempt to swim further than 150 m underwater while holding her breath at the Sea Point swimming pool. Image by Mark van Coller..

AlertDIVER www.dansa.org Diver www.dansa.org 10 ALERT

DIVE

OVER THE MANY YEARS THAT HUMANS HAVE PRACTISED BREATH-HOLD DIVING, IT HAS GROWN TO BECOME AN IMPORTANT PART OF BOTH COMMERCIAL AND RECREATIONAL DIVING. LET’S TAKE AN IN-DEPTH LOOK AT ITS HISTORY AND EVOLUTION.

HAMLET

was not renowned for his diving skills, but the famous words from the play allow for easy moulding into the subject of breath-hold diving. In this multi-part series, we will explore the activity of breath-hold diving in greater depth and peruse several avenues emanating from there. This first part will be concerned with a historical overview, definition and an imperfect differentiation of the various kinds of breath-hold diving.

HISTORICAL OVERVIEW In living knowledge, humans have always been drawn to the sea; in awe of its beauty and majesty, yet fearful of its ferocious power and destructive ability.

The treasures yielded from its depths have inspired many to venture in, brave the myriad hazards and possibly harvest a rich reward. This deep urge to explore and reap the bounty of the oceans is probably what drove early humans to start entering the water and naturally from there try to access the underwater environment. In so doing, breath-hold diving was born.

No one can say for sure when or where breath-hold diving first started, but speculation abounds nevertheless. Evidence exists that suggests that since the dawn of recorded history breath-hold diving has taken place.

For several thousand years humans have been holding their breaths and Alert Autumn 2012 ALERT

Diver 11 DIVER

DIVE

submerging themselves underwater. The main purposes thereof would be gathering food and collecting materials. One could assume, based on human nature, that a sort of competitive and recreational type of breath-hold diving also existed amongst these early divers.

Several examples of breath-hold diving exist in historical records and some groups are still currently active. Greek sponge divers have been known for hundreds of years to look for the ever-dwindling sponges in the waters of the Mediterranean Sea. During Greek and Roman periods, breath-hold divers were used at various times to carry out military and salvage operations. For about 2000 years, the Ama divers of Japan and their equivalent in Korea have been breath-hold diving for shells and seaweeds. The interesting thing is that it is the women who do the diving, with the males serving as tenders, because it appears as if the women tolerate the cold water better. Another suggestion is the persistent “folklore” that diving reduces the virility of males. Whatever the reason may be, the style of diving has remained relatively unchanged over the centuries, with the addition of masks, fins and wetsuits being the only real changes affected in recent times.

Another example of an industry involving breath-hold diving which has persisted into modern times is the pearl divers of the Tuamotu Archipelago.

Marco Polo observed pearl diving on the Coromandel Coast during travels to India and Sri Lanka. The Spaniards regularly exploited Native American Divers for pearling, salvage and smuggling, notably those from Margarita Island, their high value on the slave market indicating the demand for divers.

Freediver Sophia van Coller freediving in Cape Town, using a mask, weight belt and monofin. Image by Mark van Coller.

‘‘

IN LIVING KNOWLEDGE, HUMANS HAVE ALWAYS BEEN DRAWN TO THE SEA.

Humans are not designed to exist in the subaquatic environment, with the obvious limitation of breathing being the single biggest stumbling block.

However, humans do possess a thinking ability and a creative nature that allow this obstacle to be overcome. Initially, and for several thousand years, humans relied on the simple technique of just holding their breath underwater to enable them to explore this alien environment. In a nutshell, that is exactly what breath-hold diving is.

DEFINITION Breath-hold diving is really any form of submersion underwater (or potentially any other liquid) whilst holding one’s breath. Based on this definition, putting one’s head under the water while in the bath would qualify. Let us allow common sense to prevail and consider breath-hold diving to be submersion underwater whilst holding one’s breath and engaging in a purposeful activity.

DIFFERENTIATION Breath-hold diving started out of necessity and desire, but in recent years the recreational aspects have become more important. Sports have originated AlertDIVER www.dansa.org Diver www.dansa.org 12 ALERT

DIVE

‘‘

BROADLY SPEAKING, ONE CAN FORM TWO GROUPS OF BREATH-HOLD DIVERS: COMMERCIAL AND RECREATIONAL

from breath-hold diving techniques in combination with other sporting methods.

Many methods can be employed to categorise the different forms of breath-hold diving, but let’s stick to the simpler ways. Broadly speaking, one can form two groups of breath-hold divers: commercial and recreational, rather analogous to what is considered in compressed gas diving.

Commercial breath-hold diving is where breath-hold diving is used as a vehicle to take workers to their place of industry, in order for them to accomplish whatever tasks necessary. An example of this would be pearl diving, which still takes place to this day. Modern commercial diving – with specialised equipment and compressed gases – has largely eclipsed this form of breath-hold diving.

Recreational breath-hold diving can be further subdivided into pure recreational and sport breath-hold diving. Purely recreational would really be where breath-hold diving techniques are used to enjoy the subaquatic environment and derive relaxation from it. Freediving and snorkelling with downward excursions would be examples of this. Sport breath-hold diving encompasses various types of sport that either primarily focus on the breathhold diving or incorporate the techniques to create a new activity. Examples include competitive freediving, spearfishing, synchronised swimming, and underwater hockey and rugby.

A third possibility to keep in mind is the reluctant or unwitting breathhold diver. In this scenario, one would find someone who suddenly becomes a breath-hold diver because of unforeseen or unexpected circumstances. An example would be a scuba diver who suddenly runs out of air.

In the following parts of this series of articles, we will further explore the fascinating realm of breath-hold diving. Stay tuned! AD

References 1. Brubakk Alf O. & Neumann Tom S. Bennett and Elliot’s Physiology and medicine of diving. 5th edition.

2. Edmonds C., Lowry C., Pennefather J. & Walker R. Diving and subaquatic medicine.

4th edition.

3. www.britishfreediving.org 4. www.freediving.co.za 5. www.freedive.net 6. www.skin-dive.com 7. www.deeperblue.com 8. www.freedivers.net

Freediver Paul Winter freedives down a line in Cape Town using a mask, weight belt, bifins and a lanyard for safety. This discipline is called Constant Weight with Fins. Image by Mark van Coller.

Alert Autumn 2012 ALERT

Diver 13 DIVER

STATISTICS

DAN-SA Hotline Activity report for 2011

By Dawn Avice du Buisson

THE

DAN hotline is renowned for having the most highly-trained diving doctors and call centre agents in the world. They passionately impart a wealth of knowledge and experience when DAN members contact them, providing them with up-to-date dive medical advice and assistance.

Nobody says it better than a Zanzibar dive instructor who, when asked why DAN is so special, unhesitatingly answered, “Because the DAN hotline saved my life!”.

Statistics reported are from 1 January 2011 to 31 December 2011 Emergencies 182 Non-emergencies 235 Email queries 124 Air evacuations 12 Road ambulance evacuations 5 Self-drive evacuations 58 Chamber recompression 20 Hospital admissions 17 Out patients 130 Surface O2 provided at scene 43 Decompression illness 30 Pulmonary barotrauma 8 Ear barotrauma 27 Other barotrauma 10 Air embolism 1 Hazardous marine life injury 12 Trauma – dive related 15

Twelve flight evacuations were facilitated in 2011. These were a mix of fixedwing air ambulances, medical helicopter and commercial flights. There were five road ambulance evacuations; the prevalent areas remain Sodwana Bay and Manguzi.

Sadly, we had six fatalities reported to us during 2011. Our condolences to the families and friends of these divers.

WHEN TO CALL THE DAN HOTLINE:

For non-emergencies: – If you have concerns about a chronic condition and the associated risks of scuba diving.

– If you have questions about a medication you are taking while scuba diving.

– If you require any advice regarding general medical fitness to scuba dive.

– If you would like a referral to a dive physician for an assessment.

– If you would like to enquire about evacuation options available for the area you will travel to and to assist with your emergency plan preparation.

– If you need to make a claim – as per the DAN membership benefits (remember that all claims must be approved by the hotline BEFORE expenses are incurred!).

You can also email your query to: danmedic@dansa.org For emergencies: – If you develop any symptoms after a dive and want to check with a doctor if they are related to DCI. – If you sustain an injury on a dive and would like to enquire as to the appropriate, recommended treatment.

– If you have an emergency on a dive, and require ambulance assistance (DAN will contact an ambulance on your behalf, and if necessary offer treatment advice to ambulance staff and receiving facilities).

– If you require a referral to a doctor or chamber facility (DAN will contact a facility to assist with making arrangements for an appointment).

– If you need pre-authorisation for medical expenses for a dive-related injury – as per the DAN membership benefits.

Please contact the hotline as soon as possible for any approvals for costs, i.e. evacuation costs or chamber costs. AD

Trauma – non-dive related 4 Non–dive related 41 Other 137 Malaria prophylaxis 24 Fitness to dive query 218 Swimmer’s ear 14 Fatalities 6 AlertDIVER www.dansa.org Diver www.dansa.org 14 ALERT

24-hour DAN hotline: 0800 020 111 locally, or +27 82 810 6010 from outside of South Africa.

The hotline is available 24 hours/365 days a year, and accepts collect calls internationally. Please remember to activate your cell phone roaming if you are travelling outside of the South African border, or check that you will have use of a phone that can call internationally for emergencies.

STATISTICS

Distribution Statistics

By Toni Krige-McQuillen

DAN annual & student membership

ANNUAL MEMBERSHIPS The admin team at the DAN office is tasked with the simple goal of providing exceptional service to our members. We want the service provided to our members to be the best they have ever experienced. With 15 years’ experience as a not-for-profit medical organisation, we understand that a dive trip is all about living the dream. Our well-trained staff members put their hands-on approach to work every day to ensure that your membership applications and queries are dealt with, so that you need not worry when enjoying the dive trip of a lifetime.

The DAN-SA membership distribution list with active members for 2012 appears to the right. It is always interesting to see where the bulk of the memberships are held, but also interesting to see the other countries DAN covers.

STUDENT MEMBERSHIPS The student membership programme is available to entry-level scuba students and has grown over the last few years providing a wonderful base for new divers to be introduced to the world-class service DAN offers. This programme allows them the benefit of DAN cover free of charge during their introduction to scuba diving. An ever-growing percentage of members were previously student members, which shows the significance of this free programme made available to scuba instructors who are active DAN members. The list to the right features the areas where instructors have trained and made use of this membership during 2011. AD

The DAN-SA distribution list continues to evolve, and for that reason DAN would like to thank its members for their support. Without its members, DAN would not exist and divers would not receive the critical service offered by DAN. DAN hopes to increase their numbers as divers learn more about the importance of the services we offer.

For more information please feel free to visit our website www.dansa.org or email us at mail@dansa.org You can also phone us on 0860 242 242 or +27 11 266 4900.

South African Distribution of Members and Students Trained Members

Students

Unknown addresses in SA

167

Eastern Cape

34

Free State

125

21

Gauteng 5504

1067

KwaZulu-Natal

873

107

431

Limpopo

85

Mpumalanga

396

Northern Cape

20

North West

281

52

Western Cape

843

300

TOTAL 8328

2063

85

International Distribution of Members and Students Trained Members

Students

Botswana

15

Kenya

10

Madagascar

22

1

Malawi

5

2

Mauritius

19

2

Mozambique

22

2

Namibia

74

34

Seychelles

5

St Helena

3

Swaziland

8

Tanzania

28

U.K.

6

U.S.A.

1

TOTAL

218

510

551 Alert Autumn 2012 ALERT

Diver 15 DIVER

MEDICAL

All about

Head Injuries

By Dr Lourens de Kock

HEAD INJURIES CAN BE VERY TRAUMATIC WITH REPERCUSSIONS THAT CAN LAST A LONG TIME. LET’S TAKE A DETAILED LOOK AT HOW HEAD INJURIES CAN AFFECT DIVING.

HEAD

injuries (HI) are notoriously difficult to assess when considering fitness to return to diving activities. The main reason for this is the fact that there is a lack of consistent definitions when classifying patients with head injuries into the traditional three categories of “mild”, “moderate”, and “severe”. The differences between the last two groups are usually obvious and thus not confused easily, but differentiation between the mild and moderate groups seems to be an internationally contentious topic.

The second reason is that it is very difficult to evaluate the outcome of mild and moderate HIs due to a lack of proper, accurate measuring tools and paucity of properly researched populations with previous HI. It will be AlertDIVER www.dansa.org Diver www.dansa.org 16 ALERT

demonstrated that every diver with an HI must become a “very special” case, with special interest invested by the treating doctor as well as the diving medical physician that will be evaluating the diver for fitness to return to diving.

In-depth investigations (a proper and complete history is of crucial interest) are required and elaborate collegial assistance and opinion should be gathered to ensure an accurate prediction of diving fitness. Most cases should be given the benefit of scrutiny by a group of experts, like the SAUHMA Diving Medical Panel, especially when the future of an occupational diver (including recreational dive masters and instructors) is at stake.

Let’s first of all have a look at the incidence of traumatic brain injuries (TBI). TBIs are one of the most common neurological disorders, especially affecting young adults in the second and third decades of their lives.

Epidemiological studies in the U.K. and U.S. indicate this figure to be 100 to 300 per 100 000 inhabitants. The majority (80-85%) of these patients are classified as mild head injuries (MHI), 10% as moderate and 5-10% as severe head injuries. The problem with the 90-95% that is not severe is that a significant subgroup persists, with residual symptoms interfering with return to work or resumption of social activities. We can therefore extrapolate that a return to diving would automatically also be problematic for this subgroup of divers with mild or moderate HIs.

MEDICAL

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TRAUMATIC BRAIN INJURIES ARE ONE OF THE MOST COMMON NEUROLOGICAL DISORDERS.

DIAGNOSTIC INTERVENTIONS

Various classification systems have been designed over the years, but the system agreed upon by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine in 1991 should be used. An MHI is therefore defined as an impact or injury to the head with at least one of the following criteria: 1. Any period of loss of consciousness (LOC), but the duration thereof being less than 30 minutes and the person’s Glasgow Coma Scale (GCS) score should be 13-15 after the LOC. 2. Any loss of memory for events immediately before or after the accident, but this “post-traumatic amnesia” (PTA) must not exceed a period of 24 hours.

3. Any alteration in mental state at the time of the accident (e.g. feeling dazed, disorientated or confused).

4. Focal neurological deficit or deficits that may or may not be transient.

This definition of a mild HI provides a clear upper limit with the lower limit allowing patients with negligible injuries to also be included in the group. All

GLASGOW COMA SCALE Eye opening

Verbal response

Motor response

Maximum score

researchers are, however, not in agreement as to the acceptability of these criteria.

Moderate HI is defined by a GCS of 9-12 (without any additional criteria).

The recording of the GCS and PTA, however, still remains necessary and recording of the presence of focal neurological deficits or brain lesions is important until internationally applicable definitions for mild and moderate HI are accepted.

Score spontaneously

4

to speech

3

to pain

2

none

1

orientated

5

confused

4

inappropriate

3

incomprehensible

2

none

1

obeys commands

6

localises to pain

5

withdraws from pain

4

flexion to pain

3

extension to pain

2

none

1 15

The role of imaging studies in the mild and moderate HI group remains controversial. Various authors note stringent criteria as indication to scan early, while others adopt a slightly more conservative approach. It is, however, important to take cognisance of the scope of application for the different imaging studies. Computed tomography (CT scan) is the standard imaging technique because of its higher accuracy in detecting haemorrhages in the acute phase. Magnetic resonance imaging (MRI scan) has been found to be more sensitive to detect abnormalities in the brain’s white matter or nonhaemorrhagic contusions in the late post-traumatic period. Since CT scanning is seldom performed in all patients, conclusions concerning the relation of CT abnormalities and outcome are inconclusive.

Other tests include “evoked potentials”, which are used as a clinical test of neurological function. An EEG (measuring the electrical activity of the brain) is useful in predicting poor outcome in comatose patients. In mild and moderate HI the presence of normal sleep activity during the EEG has been shown to be favourable.

OUTCOME INDICES AND PATTERNS OF RECOVERY

Unfortunately, most outcome indices that are applied in brain injury research have been designed for the evaluation of severe head injuries, where diving fitness is usually easier to assess. Most outcome measures focus on functional disability without objectively measuring cognitive deficits, while we know that the lighter grades of HI’s debilitating effects stem from the latter and this fact makes diving fitness standards difficult to interpret and apply. The Glasgow Outcome Scale (GOS), which is not to be confused with the Glasgow Coma Scale, is the most popularly used outcome index.

DEFINITION of post-traumatic amnesia (PTA): A specific length of time following trauma, during which the patient is unable to store current events OR a specific length of time following an injury until the return of conscious memory, including periods of unconsciousness, confusion and disorientation.

VALUE of PTA: In mild and moderate HI, the assessment of PTA is expected to be more reliable in predicting fitness than the GCS. This symptom is therefore very important to quantify correctly from the outset because retrospective recollection is almost always flawed. An external observer needs to take responsibility for noting this symptom prospectively.

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MEDICAL

Most frequently reported symptoms/complaints in mild head injury patients: – Headache – Fatigue – Memory impairment – Concentration loss – Dizziness – Irritability In different MHI studies the symptom rate varies from 15-50%, with most patients suffering these during the first week, but up to several months after the injury. One study reported that a large portion of patients still experienced complaints three months after injury; only one in six was symptom-free. The majority (78%) suffered headaches while 59% suffered memory deficits. Up to 50% of patients report symptoms for one or even more years after injury. In the MHI group it was found that patients with evidence of focal brain lesions had an increase in moderate disability. The GOS at three and six months vary according to different studies, from 78% to 97%.

In moderate HI these figures are worse. The main complaints are headaches (93%) and memory problems (90%). At three months post event almost 66% are unable to return to work due to these persistent symptoms.

The GOS at three months yielded only a 38% “good recovery” portion while 49% of patients suffered moderate disability in a study by Rimel et al. in 1982.

A study in a different socio-economic population revealed six-month GOS figures of 75% good recovery, with the remaining 25% suffering moderate disability.

Mean time “off work” in MHI cases (as described in various studies): – Varies from two to three weeks.

– Majority of patients will be back at work after three months (they will not all be without symptoms!).

– 33% of gainfully employed patients before the accident were unable to return to work.

– In 20% of patients, return to their previous work was impossible or only possible with limitations, one year after the accident.

– Even non-hospitalised patients, who resume work quickly, are not free of complaints.

– The symptoms contributing to delayed return to work are memory and concentration impairment and “difficulties” at work.

– Long-term follow up revealed that 88% of MHI patients had resumed fulltime work.

Mean time “off work” in moderate HI patients (as described in various studies): – After three months approximately 33% of patients had returned to work.

– Approximately 80% of patients had resumed full-time employment after several years of follow-up.

The follow-up consultation is deemed very important not only for establishing an objective measure of progress but also as a very important channel of information and crucial source of motivation and support. It has been proven that patients not attending follow-up visits may quit work because of persisting symptoms. They should be encouraged to persist through the initial temporary increase in symptoms after resumption of full-time work.

FACTORS NEGATIVELY INFLUENCING RETURN TO WORK – Low pre-injury occupational status – Older age – Lower GCS scores on initial assessment AlertDIVER www.dansa.org Diver www.dansa.org 18 ALERT

– – – – – –

Physical and psychological difficulties Alcohol/drug overuse Neuropsychiatric history Lower levels of motivation to work Poor social support or coping strategies Occupations: - requiring high levels of interaction - encompassing frequent interruptions - requiring simultaneous attention to multiple projects

AM I FIT TO DIVE, DOC?

In the light of the information given above we need to consult various guidelines to be able to make a decision about a return to diving. In South Africa there are no set rules regarding fitness for diving following a head injury. International, aviation and academic guidelines are consulted en masse in each case to arrive at a final “verdict”. Due to the individual nature of each

MEDICAL

and every case it is also necessary to consult medical research articles to guide the decision. A few guidelines will be highlighted that outline broad concepts around the assessment of fitness to return to dive in someone who has sustained a head injury.

The most relevant guideline can be found in the Medical Assessment of Working Divers handbook published by the European Diving Technology Committee. In section 4.8 the authors highlight the obvious risk/danger of a head injury as “mechanical vulnerability” of the brain (working divers often work in construction-like conditions) and post-traumatic epilepsy. They classify HIs by a system where only the duration of LOC is used; GCS is not considered.

A “Grade I” HI is defined as a head injury with <30min LOC with no evidence of a skull fracture, while “Grade II” is defined as any head injury with a cranial fracture and/or LOC lasting 30 minutes to 24 hours. It is accentuated that a proper history is taken, together with the scrutinising of medical records (especially post-surgical and intensive care notes). Neurophysiological residues should also be excluded by a qualified professional.

They list absolute contraindications for diving as: – Any current open craniotomy wound – Residual neurological findings upon examination – Epilepsy following craniotomy For head injuries they provide the following guidelines: – Grade I may return to diving after 10 days – Grade II may return to diving after six months, provided there are no neuropsychological findings Dr Alan Kayle, a South African author, in his book Safe Diving recommends: “HI at any time in the past resulting in even brief unconsciousness and no residual brain damage requires a full neurological assessment, including an EEG (with hyperventilation tracing). Any abnormality excludes diving”.

Internationally renowned authors Edmonds, Lowry, Pennefather and Walker recommend that candidates with any features of mild or moderate HI, with normal results following complete medical investigation, should be free of seizures, should not require any drug therapy and should be functioning normally in their daily lives before consideration can be given to pass them as fit for diving activities. They further recommend that divers with a history of penetrating HI, with PTA >24 hours, a depressed skull fracture or an acute haematoma should not dive for at least five years because of the risk of late post-traumatic epilepsy.

It is of great assistance to compare aviation protocols on head injury because of the similar high risk that pilots are exposed to in their daily flying lives. Comparisons and equal standards for fitness have been accepted and applied for many years. The Civil Aviation Authority of South Africa’s protocol regarding mild and moderate HI is tabled on the right.

DEFINITION

MILD HEAD INJURY

MODERATE HEAD INJURY

LOC/PTA <30 minutes

LOC/PTA >30min but <24hr

No neurological deficit

Focal neurological deficits

No compounding factors (fracture, vertigo, headache)

Skull base fracture

Surgical penetration of the dura mater (the outermost, tough membrane of the brain) RECOMMENDATIONS HI with impaired consciousness (no LOC): grounded for seven days to exclude possibility of post-traumatic epilepsy. Fleeting LOC and/or amnesia: grounded for six weeks.

These applicants tend to recover fully and may then fly without restrictions.

If the PTA >12hours: unfit for two years; whereafter the pilot can reapply. The examination should be co-ordinated by the Institution for Aviation Medicine. A series of special investigations are required (e.g. sleep deprivation/ photostimulation EEG, CT/MRI scans, neuropsychological examination, etc.). In addition, a practical flight test is required.

The panel will decide on fitness; either fit with restrictions or unfit.

recovery of the HI. In this regard, it requires exceptional interpersonal skills from the examiner to get his hands on all of these pieces of information.

Head injuries can become complicated. This problem changes the whole playing field and often requires intensive medical literature research to shed some light on the risks of returning to diving activities. Successful evaluation of a diver with a head injury requires collaboration between a qualified dive medical physician, a dive medical consultant and the relevant neurological specialties. AD

SUMMARY AND CONCLUSION

Divers who sustain head injuries present unique challenges when they present for medical assessment and they want (or need) to return to diving activities.

Numerous factors complicate the evaluation of which the initial classification, challenging and contentious treatment regimens as well as the poor indices measuring outcome are paramount.

A detailed history taken by the examiner from the diver is rarely sufficient.

In-depth research should be conducted to elicit all the fine details. Emergency room, surgery and even ICU or ward records are required to get a proper idea of the grade, the exact medical interventions and the observed progress of

References 1. Van der Naald J. Prediction of outcome in mild to moderate head injury: A review. J of Clin and Exper Neuropsych, 2001;23(6):837-851.

2. Wendling J., Elliott D.H., Nome T. The Medical Assessment of Working Divers, 2004. 1st edition. Biel, Switzerland: Hyperbaric Editions, p107.

3. Kayle A. Safe Diving – A Medical Handbook for Scuba Divers, 1995: p55.

4. Edmonds C., Lowry C., Pennefather J. & Walker R., eds. Diving and Subaquatic Medicine, 2002. 4th edition. London: Arnold, p547.

5. Current Protocols of the Institute for Aviation Medicine. Schedule 1: Neurological or Neurosurgical Problems – Head Injuries.

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Diver 19 DIVER

MEMBERSHIP

What makes DAN special?

By Toni Krige-McQuillen

DAN HAS PROVIDED SERVICES TO DIVERS FOR YEARS, BUT FEW REALISE THE EXTENT OF DAN’S DEDICATION. FIND OUT MORE ABOUT WHAT MAKES DAN ONE OF A KIND.

DAN

was created to fill a need in the industry for medical expertise in diving-related injuries, but what really drives us is our passion for diving and divers; this is the core of our mission and what makes us the best at what we do. One might say that DAN is a monopoly in the industry or mistake us for insurance, however, it may interest you to learn that DAN is a non-profit organisation. What makes this such an important point? Well, it is simple. It means that our focus is purely on the member and not on profit. Our dedicated doctors donate their time to DAN members, and the employed staff members of DAN believe in the mission of dive safety.

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OUR FOCUS IS PURELY ON THE MEMBER AND NOT ON PROFIT.

The fact that DAN is a non-profit organisation benefits all divers, and allows us to have a 24-hour emergency hotline. As a diver, you will have heard about the wonderful work that has been done by the hotline, with long hours and staff that are dedicated to looking after injured divers. This may not seem like a big deal to outsiders, but as we have learnt from the start of our diving courses even safe diving practice is not a prevention from a diving accident, and many things that are out of our control can affect our dives. When these accidents happen, you need to consider the destination diving takes you to, and you may have noticed that these are mostly remote locations. It is amazing how paradise can become a nightmare when something like a diving accident happens and there are few medical facilities available (never mind diving medical expertise). This is where DAN can seem like the light at the end of the tunnel, and be reassuring to a diver when these unforseen incidents occur. We assist not only in your medical treatment or evacuation efficiently and with expertise, but also in reassuring you and assisting you in getting the right help you may need for that particular incident.

But DAN is not all doom and gloom. We are not just here for emergencies,

AlertDIVER www.dansa.org Diver www.dansa.org 20 ALERT

Image by Cormac McCreesh.

but also as a source of helpful information to you, the diver. You may have a medical enquiry, or a medication enquiry, or perhaps you just want to know more about what medical conditions are safe to dive with. Whatever your needs, our hotline provides you with free assistance, and you can call the emergency number 24 hours a day and receive the information you require from a friendly expert. DAN has also provided members with a lot of this information on our website, so feel free to visit us on www.dansa.org DAN also contributes towards dive-safety research. The very start of diving medicine was researching medications and physiology when diving. It is an evolving medical field and there is always more we can learn from this research which relies heavily on member funding.

DAN also has a professional administration office, which maintains your membership and keeps you up to date on the latest DAN news. The DAN office is key in ensuring that our members get relevant renewal notices and membership cover information, and that our members’ cover is in place. Both new and old members are always impressed with this level of service, and you will often hear about it from fellow DAN members. It is our pleasure to be of service to all divers alike.

‘‘

YOU CAN CALL THE EMERGENCY NUMBER 24 HOURS A DAY AND RECEIVE THE INFORMATION YOU REQUIRE FROM A FRIENDLY EXPERT.

As you can see, all the above makes us a very important team; one that works together to make sure that our DAN members are looked after not only in their time of need, but even when just looking for information, regardless of its importance. It is all a priority to us, and so are our members. AD

We’ve got you covered while training

MEMBERSHIP

Entry-Level Student Dive Accident Cover Emergency Hotline and Medical Information Line Emergency Evacuation Cover Hospitalisation Medical and Chamber Treatment

www.dansa.org Alert Autumn 2012 ALERT

Diver 21 DIVER

MEDLINE

Medical queries and NOTE: Many of the original questions and answers have been altered slightly to ensure confidentiality.

By the DAN medical staff

Q | I’ve been diving for 20 years, and my ears are getting the worse for wear.

I hear many people singing the praises of vented earplugs. What is DAN’s opinion of them?

A | In the past 10 years no new information has surfaced to warrant any change in DAN’s recommendations regarding the use of vented earplugs.

Although traditional non-vented earplugs are never appropriate for diving, some divers report improved equalisation while using vented earplugs. Others, however, report no improvement. Manufacturers of these products claim they make equalisation easier, but since pressures must still be equalised we do not know why that would be the case. Although the ear canals may remain drier, this does not change the fact that the pressure in the middle ears must still equalise to the surrounding water pressure. Originally, vented earplugs were designed to reduce the occurrence of otitis externa (swimmer’s ear). For this purpose the earplugs have demonstrated some value. We know of no consistent evidence, scientific or anecdotal, to confirm significant improvement of equalisation.

Long-time DAN consulting physician and ear, nose and throat surgeon, Dr Cameron Gillespie, recently confirmed that people are not likely to be injured by using vented earplugs while diving. However, Gillespie does have some reservations about their use on the surface. Earplugs inhibit normal hearing

22 AlertDIVER

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and may hinder buddy communication and awareness of crew instructions.

If earplugs are worn with the hope of easing the process of equalisation, they should not be used in an attempt to compensate for sinus congestion or other major obstacles to equalisation, as these obstacles preclude diving. In addition, since the risk of leaking cannot be eliminated completely, diving with a perforated eardrum or pressure-equalisation tubes is not recommended at any time — with or without earplugs.

John U. Lee, MSDT, EMT, CHT, DMT DAN medical information specialist

Q | When administering first aid oxygen to an injured diver, is there a risk of oxygen toxicity? I’ve heard about “air breaks” — are those necessary when providing first aid oxygen?

A | There are two forms of oxygen toxicity, and they are identified by the area of the body most affected: the central nervous system (CNS toxicity) and the lungs (pulmonary toxicity). Each results from a particular type of exposure to oxygen.

CNS toxicity occurs only in hyperbaric environments (those in which the pressure exceeds sea-level pressure) and can manifest as seizures. The risk of seizure due to CNS toxicity accounts for the generally accepted oxygen partial pressure limit in recreational diving of 1.4 ATA. CNS toxicity risk increases as the partial pressure of oxygen increases.

Within hyperbaric chambers, the maximum oxygen partial pressure allowed is 3 ATA. Most treatment protocols are performed at 2-2.8 ATA of oxygen. Exposure to these levels is appropriate in controlled clinical settings and is not harmful. In the event of acute oxygen toxicity, the controlled, dry environment is not associated with the risks divers face, like drowning. To further reduce the risk of oxygen seizure during hyperbaric treatment, some facilities also provide air breaks, which are thought to reduce oxygen seizure risk. Despite the high oxygen partial pressures experienced in hyperbaric chambers, seizures are very rare.

Pulmonary toxicity, on the other hand, results primarily from prolonged exposures, not just elevated oxygen partial pressures. However, the onset of pulmonary toxicity is accelerated in hyperbaric environments.

Pulmonary oxygen toxicity describes the irritation of lung tissue resulting from excess free radical production. The prolonged use of high concentrations

MEDLINE

answers of oxygen can overwhelm our cellular defenses. Symptoms may include substernal (behind the sternum) irritation, coughing, a burning sensation with inspiration and reduced pulmonary function. When breathing 100% oxygen at sea level, symptoms may occur after 12-16 hours of exposure. As such, pulmonary toxicity is generally not a concern in open-circuit recreational diving and other prehospital settings, and it does not require special prevention strategies or the use of air breaks.

From time to time, we hear about divers administering oxygen first aid and confusing it with chamber treatment protocols by giving air breaks to the injured diver. Air breaks are unnecessary and inappropriate for a diver breathing 100% oxygen at near-surface pressure. Giving air breaks while administering oxygen first aid diminishes the oxygen pressure gradient and reduces the oxygen window by introducing nitrogen into the diver’s breathing gas. This slows the elimination of nitrogen from the diver’s body.

If you participate in prolonged evacuations from a remote location, allowing occasional air breaks is acceptable, although these would happen naturally as the diver eats, drinks and goes to the bathroom. It isn’t necessary to plan these air breaks at regular intervals.

Nicholas Bird, M.D. and Eric Douglas

Q | I’ve just finished a week of heavy diving, and many people in our group have scheduled massages for the afternoon of our last day at the resort.

Is it possible that a deep-tissue massage could lead to an increased risk of decompression sickness?

A | Massages have not been clearly associated with any cases of decompression sickness (DCS) in which DAN has been involved, and we are not aware of any study done to address this question. The simplest piece of advice is that postdive deep-tissue massages should probably be avoided so the risk of diagnostic confusion is minimised. Deep-tissue massages, like exercise, have the potential to cause soreness in tissues and joints that may be similar to symptoms of DCS. Such diagnostic uncertainty can cause significant anxiety, lead to unnecessary hyperbaric chamber treatment and, most dangerously, result in divers ignoring actual symptoms of DCS, believing them to have resulted from the massage.

A more speculative and purely theoretical concern is the risk of bubble micronuclei development. The nature and action of micronuclei have not

been confirmed, but it is believed they are the seeds from which bubbles form. Tissue stimulation could increase blood flow, which may either enhance elimination of gas from tissues or precipitate problematic bubble formation.

There is no clear sense of what a massage might do, and this effect would likely vary depending on dive profiles and the intensity of the massage.

Conservative depth/time profiles are the most reliable way to mitigate DCS risk.

John U. Lee, MSDT, EMT, CHT, DMT DAN medical information specialist Autumn 2012 Alert

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MEDICAL

BLOOD UP Incident Insight

By Dr Gary Morris

HOW A CONGENITAL LUNG DEFECT LED TO A CASE OF PULMONARY BAROTRAUMA IN A YOUNG DIVER WHO WAS UNAWARE OF THE DEFECT’S EXISTENCE, AND WHO IGNORED WARNING SIGNS AFTER A DIVE.

SOME

years ago, a family living inland went diving for the weekend on the KwaZulu-Natal coast. Both father and son were divers. The young man (in his late teens) was a very good swimmer and had represented the provincial team in water polo.

The experienced divers did two easy, uneventful dives out on a reef on the Saturday morning. Afterward, they rested at the bed and breakfast where they were staying, and that evening went out for a meal. Soon after they had retired to their rooms, the son called on his father to say that he felt breathless, was coughing, and had coughed up some blood.

In the early afternoon, after the dives, the son had felt a slight tightness in his chest and noticed that he coughed out a little bit of pinkish fluid. He lay down, and it eased slightly. The tightness was still there when they went out for supper, and seemed to get slightly worse during the evening. He had hoped it would ease again when he got into bed, and that he would be ready for two more dives on the Sunday morning. When he lay down at about 21:00, the coughing seemed to get worse and he coughed up some dark red blood.

This really worried him, so he woke his father, who then called one of the local diving doctors to see him.

The fit young man was slightly short of breath, coughing and had reduced air entry into his right chest. He was thought to have a pneumothorax (air leak into the chest cavity) and was referred to a thoracic surgeon. A chest drain was inserted to remove the air from the chest cavity, and he was kept in the intensive care unit. After a few days he was sent home, and at a later date saw a cardiothoracic surgeon in his home town, where an operation was done to AlertDIVER www.dansa.org Diver www.dansa.org 24 ALERT

close a congenital bullous (blister) on the top of his lung. He was not able to undertake further diving.

This fit young swimmer had a congenital defect in his lung which made him vulnerable to barotrauma of the lungs. This condition was something which would not be picked up through a screening questionnaire or through a pre-diving medical examination. He was fit and excelled in water sport; he had dived within decompression limits and had done no sudden ascents, but had ended up with a serious condition.

‘‘

THIS CONDITION WAS SOMETHING WHICH WOULD NOT BE PICKED UP THROUGH A SCREENING QUESTIONNAIRE OR THROUGH A PRE-DIVING MEDICAL.

The volume changes which occur with pressure changes in diving have their effect on gas-filled cavities like the ears, sinuses and lungs. Small changes in pressure and shallow depths can cause damage to these organs, and a weakness in the tissue will increase the possibility of something being damaged. A bullous is a thin-skinned cavity on the lung surface, which is

MEDICAL

normally not dangerous and is contained by the chest wall. A person afflicted by this is usually unaware of its existence. This diver had done several dives with no problems up to this point. As a result of having this weak spot in his lung, the pressure/volume changes caused pulmonary barotrauma. This occurred in diving circumstances in which one would not expect something to go wrong and in an individual that one would not expect to have problems.

Pulmonary barotrauma is more common in novice and inexperienced divers, and is associated with panic. This is probably related to factors such as lack of familiarity with the equipment, not monitoring gas supply, relative unease in the water and a greater likelihood of panic.

The usual circumstances that result in pulmonary barotrauma are: 1. Panic, with an attempt at an emergency ascent.

2. Free ascents, including ascents in submarine escape training.

3. Skip breathing.

4. Unco-ordinated buddy breathing leading to panic.

5. Inability to gain control of the regulator and abandoning the exercise, returning hurriedly to the surface.

6. Apparatus difficulty, such as a high regulator resistance.

7. Water inhalation, leading to panic and rapid ascent.

8. Lung disorders, like lung bullae.

2.

3.

4.

5.

symptoms persist or increase, you need to do something about it. Contact DAN and/or seek medical help.

Listen to your body. Even if you are a fit and experienced diver, things can still go wrong. If you feel ill or strange, seek advice from DAN or have yourself checked out by a suitably qualified health practitioner.

Fitness, and even prowess, in one type of sport does not necessarily mean the person is fit for diving.

Medical examination does not necessarily exclude all possibilities. Always be aware that the human body is not designed to be at 20 m underwater breathing pressurised gas. Volume and pressure changes can bring out problems that may not show themselves up, even during a good dive medical examination.

Diving is often done in groups, far from home. One person’s medical problem can disrupt other people’s arrangements. Often people have saved up money, travelled long distances and dive in remote areas. This puts a lot of pressure on the diver not to have medical problems or to minimise or ignore danger. Health should take precedence over holiday plans and not wanting to disrupt other people’s plans.

Again, listen to your body and if in any doubt, seek advice or discuss your symptoms with a knowledgeable person or contact DAN. AD

What can we learn from an incident like this?

1. If you are breathless and coughing up blood after a dive, especially if the Alert Autumn 2012 ALERT

Diver 25 DIVER

TRAINING

Nuts & Bolts for the future

By Francois Burman

GOOD ON-SITE SKILLS IN MAINTENANCE ARE INVALUABLE FOR THE LONGEVITY OF EQUIPMENT. THE NUTS & BOLTS COURSE AIMS TO KEEP FACILITIES RUNNING AT MAXIMUM CAPACITY BY PROVIDING A PLATFORM TO LEARN THESE SKILLS.

THERE

must be a maxim somewhere that links the concept of remoteness with the world’s most beautiful dive spots.

When you then factor the provision of specialist medical services for injured divers into this, you start to realise how challenging the role of DAN as your partner in need can be.

Back in 1999, we realised that we relied rather heavily on recompression chamber facilities in these remote spots. However, the ability of these facilities to remain sustainable, available and suitably equipped was indeed a tricky business. We needed to somehow find a means to support them, and to ensure at least a minimum level of quality of service.

IDAN (International DAN) commissioned the Risk Assessment Guide for Recompression Chambers in 1999 to provide some form of international best 26 AlertDIVER

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practices for this industry, and followed this up with a series of on-site risk assessments under the Recompression Chamber Assistance and Partnership Programme (RCAPP) over the next 12 years. From these assessments, we have been able to become a force for change and to work with these facilities on many fronts. The resulting on-site needs assessments all showed that consistent and comprehensive training in operating facilities, tending to injured divers inside the chambers, and basic dive medicine and technical skills (such as maintenance of facilities) were all high on the priority list at all but a few of these chambers.

Over the past eight or so years, Alert Diver has provided numerous articles on DAN’s endeavours to visit, assess and assist facilities, some of these in the really remote corners of the diving world, like the Galapagos Islands, Papua

TRAINING

New Guinea, Zanzibar and the Azores, to name but a few. The latest ambitious project continues in this mould and includes what we like to refer to as our Nuts & Bolts programme: Maintenance training for remote chamber facilities to empower staff to be able to keep their facilities running effectively and safely, using really basic technical skills and tools.

‘‘

WE TEACH MAINTENANCE AS A SERIES OF WELL-PLANNED, PREVENTATIVE INSPECTIONS, CHECKS, TESTS AND BASIC SERVICE STEPS.

The full scope of the training course includes some 22 different talks and covers all the aspects of the facility, from oxygen delivery and analysing equipment, through to compressors, chamber air conditioners and fire extinguishing systems. If offered in full, this could take up to five days to accomplish.

Perhaps, when one thinks of “maintenance”, the first image that one might have is seeing a complicated compressor lying on the workroom floor in its thousand individual parts! This is not, however, what maintenance really includes, and in fact, rarely is maintenance the same as repair. Rather, we teach maintenance as a series of well-planned, preventative inspections, checks, tests and basic service steps. If you care for your equipment and note when

things start to change, most often you can effect simple procedures to avoid costly breakdowns and failures.

The next mind-block to change is the concept of the maintenance technician, so more appropriately in this case, the typical profile of a suitable, first-line maintenance enabler. Most interested staff members can be taught how to accomplish 95% of the steps needed to keep a chamber facility working in good order. Comprehensive services and overhauls remain a requirement, but these can be planned for properly, and fitted into both the operating schedules and the budget where you know that everything is being done as the manufacturer intended. Much like your motor vehicle and the 10 000 or 15 000 km services, you simply cannot neglect the oil level between your planned services, and if you remember to do the basics and pay attention, your vehicle will give you many years of reliable and efficient service.

Nuts & Bolts is an IDAN initiative and once we had drafted out the course, we set about offering it to future presenters, maintainers, managers, owners and even doctors on an international front. Two comprehensive training opportunities were organised as trial runs: one on-site on the Honduran island of Utila in the Caribbean, and the other at the impressive Polish National Centre for Hyperbaric Medicine in the Baltic port town of Gdynia.

We believe that we are now ready to roll this out, most likely in smaller and more focused “doses” at the recompression chamber facilities that engage with DAN under the RCAPP. It is our hope and intention to raise the level of on-site skills at these facilities and thus empower them to be in a position to take better care of their not insignificant “investment in equipment and human resources”. AD

Removing a scratched acrylic window from inside a chamber.

Autumn 2012 Alert

DIVER 27

SAFETY

When the nightmare

becomes a reality

By Lee Griffiths

Decompression sickness can be a scary thought for divers, especially regarding the treatment process required. in this article, we discuss the steps involved so divers can know what to expect.

It’s

been a great day’s diving: no incidents, and we’ve seen more fish than at a fish market and taken enough photos to fill a dozen albums! But hold on, what’s that pain in my elbow? Why do my fingers feel numb and tingly? And why do I feel so tired? Oh no, please don’t let it be the bends! For most divers worldwide this is a scenario they all fear and dread.

So what happens next? Okay, we could all say, “Call DAN and if you need treatment go to the nearest chamber” and that could be the answer, but what really does happen when the nightmare becomes real?

Here are the facts: The vast majority of DCI cases are not life-threatening and the majority of cases respond well to treatment as long as they are treated promptly. So let’s look at an imaginary average case.

The first thing to do, as we all know, is to talk to a doctor familiar with dive medicine as soon as possible. One of the easiest ways to do this would be to call the DAN hotline. They will not only give the diver advice, but also tell him or her where the nearest facility is.

The diver will now be “in the pipeline”. In most cases, divers will make their own arrangements or use known local arrangements to get to the treatment centre (or as we divers know it: the chamber).

Once at the chamber the diver will find he or she is amongst like-minded people, as most chambers worldwide are manned or partially manned by divers or ex-divers. There is usually some paperwork to fill out and someone may put the diver on oxygen while he or she is waiting.

The doctor will then give the diver a private consultation and all information will be kept confidential. They will want to know all the symptoms the diver has, when they started and if they are getting worse, better or have

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Venting the chamber during treatment to cool the air inside the chamber.

stayed the same. The main symptoms are often called “the chief complaint”.

The doctor will then take what is known as a history of the diver and the incident. This may include things which may not seem relevant to the case, such as if the diver has been in hospital before or if he or she is taking any medication, and so on. These are standard questions and are important and asked by any doctor who is seeing any patient for the first time.

Once all the information about the diver and about the dives has been gathered, the doctor will carry out an examination looking for what (in medicine) are called objective findings. These are things that the doctor can

SAFETY

‘‘

THE VAST MAJORITY OF DCI CASES ARE NOT LIFETHREATENING AND THE MAJORITY OF CASES RESPOND WELL TO TREATMENT AS LONG AS THEY ARE TREATED PROMPTLY.

see are wrong. The examination is basically a series of tests that the doctor feels are necessary and will be based on the information that the diver gives, such as a chest X-ray or ECG (electrocardiography) to check the heart and lungs (especially if there is chest pain), but will usually start with the basics such as blood pressure, pulse, temperature and respiratory rate.

The main way in which the doctor will assess the diver is with a full neurological examination. This is a simple examination that involves very few medical instruments and takes between 20 minutes to an hour. The doctor will check the diver’s balance and co-ordination with tests similar to those given by policemen to check for drunk drivers. They will also check reflexes, strength in the limbs and skin sensitivity. These tests are an extension of the five-minute neuro exam that some divers have been taught.

Once the tests have been completed the doctor will usually make a diagnosis and start looking at the treatment the diver needs. In a few cases the doctor may call another doctor or DAN for an opinion. If the doctor believes that it is DCI then they will usually offer recompression in the chamber.

Treatment in a chamber is generally not that bad. It involves lying or

Post-dive chamber checks after a treatment.

sitting in a multiplace hyperbaric chamber (room for more than one person in the chamber) or lying in a monoplace chamber (room for just one diver).

The multiplace chamber is then pressurised with air to an equivalent depth of around 18 m. Once at the first treatment depth the diver will breathe 100% oxygen through a face mask or possibly a hood tent (which looks like a clear plastic astronaut’s helmet). If the treatment is in a monoplace chamber then the chamber itself is often pressurised with oxygen and the diver simply breathes this instead of using a mask.

The treatments prescribed by doctors are now very standardised and will usually last between 2 hours and 15 minutes (known as a U.S. navy table 5), and 4 hours and 45 minutes (known as U.S. navy table 6). These can be extended if the doctor thinks it is necessary and in some cases deep treatments to depths of 30 m or more can be used, although it is not that common to use these kinds of treatments.

The diver will then breathe oxygen for set periods of between 20 minutes and one hour during the treatment. This will be broken up by “airbreaks” which are periods of time when the diver takes the mask off and breathes the air inside the chamber, or in the case of a monoplace chamber, breathes air from a mask. This is mainly to prevent symptoms of oxygen toxicity (nitrox divers… yes, we do breathe pure oxygen at 18 m in a chamber). It is also a good time for the doctor to assess the diver to see if there is any improvement and for the diver to drink water, which is important.

Once over, the doctor will give the diver another examination to see if the treatment has worked. It may require more treatments in the chamber before all the symptoms have resolved. In a few cases, symptoms do not fully resolve but treatment continues as long as there is improvement.

So in reality, the vast majority of treatments for DCI are straightforward as long as the diver comes forward early and does not leave it too late. The big thing to remember is to think DCI and seek medical advice as soon as possible.

If the nightmare does become a reality, maybe it won’t be that scary after all. AD

Internal chamber checks before a treatment.

Autumn 2012 Alert

DIVER 29

MEMBERSHIP

CAPE TOWN

The DSP Travel Guide

By Morné Christou and Alistair Downing

UNDERWATER EXPLORERS, ONE OF DAN’S DIVING SAFETY PARTNERS, SHARES EVERYTHING YOU NEED TO KNOW ABOUT WINTER DIVING AROUND CAPE TOWN, INCLUDING SOME INSIDE INFO ON THE WRECKS LOCATED IN THE AREA.

AS

divers, our travels take us on many journeys to exceptional adventure destinations in some of the most beautiful coastal areas of the world. This is not only an experience of a lifetime that promises to reawaken your soul, but also an opportunity to experience incredible encounters with the creatures of the ocean.

By embarking on a scuba diving adventure with DAN, our members become part of our international mission to promote safety amongst divers and dive resorts and to demonstrate that prompting dive safety is not all that difficult to achieve, knowing that the DAN hotline is only a phone call away.

DAN was founded in 1983 in America as a not-for-profit organisation and we have built up a highly successful track record in assisting divers in need and improving the overall safety of scuba diving. Since 1997 DAN Southern Africa has been an independent organisation committed to ensuring the safety of its members and constantly looking at ways to implement new safety initiatives to help further its mission.

DAN Southern Africa is preparing to spread its influence across the region it serves. Today, we offer a variety of safety programmes, such as the Recompression Chamber Assistance and Partner programme (RCAPP) and the Hazardous Identification and Risk Assessment programme (HIRA). Because our most valuable asset is our members, in 2006 we launched the Diving Safety Partners programme across our region. The programme was launched to create specific safety awareness amongst dive resorts and charter boat companies and aims to help improve their preparedness to assist an injured diver when things go wrong.

Underwater Explorers is a charter boat company in Cape Town that has qualified as a Diving Safety Partner. This means that they have provided documented confirmation of the following essential safety credentials and facilities: 30 AlertDIVER

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The dive sites of Cape Town.

– – – –

Effective dive safety briefings Dive leader and skipper first aid and emergency management training Effective and documented emergency management plans Effective and documented lost diver prevention and emergency management plans We asked Alistair Downing from Underwater Explorers to share his views on the diving in Cape Town, and in particular the dos and don’ts of diving the winter wrecks in the area.

CAPE TOWN’S DIVE SITES Cape Town’s dive sites come under the general category of temperate reefs.

We do not have a particularly large variety or numbers of fish, and many of them are cryptics, so can be difficult to spot. However, when you find them they are often extremely beautiful in their detail and colouration. Our major

MEMBERSHIP

attraction is benthic invertebrates, the little critters which live on and around the rocks, and these are both plentiful and ecologically diverse. Many of them are also very colourful and make great photographic subjects.

There are also a large number of wrecks in our waters, some of which are good dive sites, though a few of them are only safely accessible to the technical diver due to their depth. They vary considerably in structural condition; some are virtually intact, others are partly or completely broken up or collapsed with a few at intermediate stages, and some are unstable and dangerous.

‘‘

OUR MAJOR ATTRACTION IS BENTHIC INVERTEBRATES, THE LITTLE CRITTERS WHICH LIVE ON AND AROUND THE ROCKS, AND THESE ARE BOTH PLENTIFUL AND ECOLOGICALLY DIVERSE.

There is a wide range of sites: some suitable for night dives, some accessible from the shore, and others only suitable for boat access. Depths range from shallow subtidal to over 50 m. The geological structure varies and this gives sites a variety of topographical characters, and the ecological character also varies considerably with general location and depth. Cape Point is considered the boundary between two marine bio-regions. You can do a hundred dives in Cape Town and still not really know the area.

Cape Town diving moves around with the weather. The South Western Cape has a Mediterranean-type climate, with most of its rainfall during the winter months from June to September.

There is a large seasonal effect, as the prevailing winds tend to be generally westerly in winter and south-easterly in summer, with more unpredictable autumn and spring conditions. There are very few periods when there is bad diving weather for more than a few days in a row, and similarly there is seldom a run of more than four or five days of really good conditions.

Predicting diving conditions is best left to locals who dive a lot and know how to read the forecasts, and is only reasonably reliable over the short term (say two to five days), though sometimes we can get it right as long in advance as a week. Swell forecasts are usually quite reliable in the short term, and are of great importance to dive planning.

The waters are temperate, with a maximum temperature in False Bay of about 23°C in summer, and minimum of around 8°C on the Atlantic side. In winter it is more commonly between 14°C and 17°C, and most of the diving is then done around Simon’s Town.

Visibility can also vary considerably, with occasional days with more than 20 m, and other times less than 2 m, depending on the previous few days’ weather.

We have a large range of sites in the Cape Town area. There are over 150 named dive sites from Robben Island to Cape Hangklip, within the range of day trips from anywhere in Cape Town, and more are found every year. Most of these sites are very weather-dependent, and it is impossible to forecast with any confidence whether any given site will be diveable on a specific day, but there is usually somewhere that is worth a dive if you really want to get in the water.

WINTER Winter in the South Western Cape is characterised by disturbances in the circumpolar westerly winds, resulting in a series of eastward moving depressions which bring cool cloudy weather and rain from the north-west, and the strong south-westerly winds over the South Atlantic produce the prevailing south-westerly swell typical of the winter months, which beat on the exposed Atlantic coastline and east side of False Bay. The mountains of the Cape Peninsula provide protection within False Bay from this wind and from the south-westerly waves.

In spite of this gloomy-sounding forecast, winter usually provides us with some of our best diving conditions, as the sheltered east side of the Peninsula may have mild water temperatures, flat seas and good visibility while it is raining and windy above the water.

The south-westerly swells are slowed by the continental shelf and refracted and diffused round the Cape Peninsula, so they have lost much of their energy by the time they curve in towards the shore on the east side of the peninsula. The irregular form of the coast here also protects some areas more than others, so the choice of dive site is dependent on the recent weather patterns.

‘‘

THERE IS A WIDE RANGE OF SITES: SOME SUITABLE FOR NIGHT DIVES, SOME ACCESSIBLE FROM THE SHORE, AND OTHERS ONLY SUITABLE FOR BOAT ACCESS.

Between the cold and rainy fronts there are frequently days of little or no wind, and mild to warm sunshine, when the water is flat and clear and the diving is wonderful.

Water temperature during winter is usually between 13°C and 17°C, so a 5 mm suit (at least) is recommended, with the full set of boots, gloves and hood. Most of the shore dives are relatively shallow, in the order of 8 m to 15 m maximum depth, which makes a drysuit less advantageous, but getting out of a wetsuit in the wind and rain pushes the drysuit up again as a desirable option, particularly if you plan to dive more than once per day. For boat dives a drysuit is great because not only are you warmer during the dive, but the boat trip is far more pleasant. It is nice to have the choice.

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DIVER 31

MEMBERSHIP WINTER WRECKS Wreck enthusiasts have a choice ranging from old wooden wrecks in Simon’s Bay to the Smitswinkel Bay wrecks, which are five ships sunk as artificial reefs on a sand bottom at roughly 30 m.

The wrecks of Smitswinkel Bay are among the best-known and most popular boat dives of the Cape Town area. The water is deep enough to reduce surge significantly and shallow enough for recreational divers, and the area is fairly well protected from the prevailing swell. The depth also protects the wrecks from the worst of the storm surge which would otherwise have broken them up much sooner. The wrecks are easy to find, large and sufficiently intact to be recognisable, and have developed a thriving ecology which includes a few relatively rare organisms.

To the north, the HMSAS Transvaal F602 was one of three Loch class frigates transferred to South African naval forces while under construction.

The ship was laid down at the yard of Harland and Wolff as HMS Loch Ard, and was launched at Belfast on 2 August 1944 as HMSAS Transvaal. The ship was sold for scrap and scuttled by explosive charges in Smitswinkel Bay to form an artificial reef on 3 August 1978.

The wreck is 94 m long, and lies more or less upright on a flat sand bottom with bows to the north-east. The wreck retains its shape to some extent, though rust is taking its toll and the mast has fallen to the port side.

The bows have broken from the rest of the hull just aft of the foredeck winch and have fallen over to starboard. Aft of this the foredeck has sheared off the topsides along the starboard gunwale and subsided into the wreckage.

The upper deck aft of the forward gun mount has collapsed, taking with it the remains of the forward superstructure. Aft of this the upper deck is open above a machinery compartment, where some heavy equipment is still moderately intact.

The quarterdeck is in relatively good condition. The deck plating has wasted away between the frames in many places, but the hull plating is mostly intact and the rudder and shaft brackets are in good condition.

The wreck of the trawler Orotava lies a few metres off to starboard, about 20 m forward of the transom.

‘‘

THERE ARE OVER 150 NAMED DIVE SITES FROM ROBBEN ISLAND TO CAPE HANGKLIP, AND MORE ARE FOUND EVERY YEAR.

The MFV Orotava was built in 1958 by Cook, Welton and Gemmel Ltd, of Beverly, East Yorkshire. It is the larger of the two trawlers and lies on the sand at about 34 m with the top of the funnel at about 23 m, and is heeled to port at an angle of about 20°. The vessel has an asymmetrical superstructure with the enclosed part offset to port and a covered walkway on the starboard side.

There are several holes in the sides and upper deck where plating has rusted away leaving only the frames and an open hatch on the foredeck forward of the winch, giving access below.

The third wreck, the Princess Elizabeth, is about 75 m to the south. The MFV Princess Elizabeth was built in 1961, also by Cook, Welton and Gemmel.

It was badly damaged by a fire and was donated to the False Bay Conservation Society along with the Orotava by Irvin and Johnson. In August 1983 the vessels were towed out to Smitswinkel Bay and scuttled. It lies on the sand at 32 AlertDIVER

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The locations of the Smits wrecks in relation to Good Hope Reef.

36 m with a slight list to starboard. The depth at the top of the wreck is about 28 m.

The gap from the Princess Elizabeth to the Good Hope is about 10 m directly astern, to the east.

HMSAS Good Hope was another of the Loch class frigates. The ship was laid down in November 1943 as HMS Loch Boisdale, and was launched at Blyth on 5 July 1944 as HMSAS Good Hope and went into service on 9 November 1944. The vessel saw service as a convoy escort during the closing stages of World War II and was for many years the flagship of the S.A. Navy. The ship was sold for scrap and scuttled by explosive charges to form an artificial reef at 15:45 on 18 June 1978. It sank in five minutes.

The wreck lies upright on a flat sand bottom with bows to the south. Most of the hull plating has rusted away on the quarter deck leaving mainly frames.

The mast has fallen and is lying over the starboard side. The main deck has partly collapsed and has caved into the wreck, still attached along the sheer line. The interior of the hull is now accessible from many places where the plating has wasted away, and also through a number of openings on the deck.

A large rectangular opening roughly amidships opens into what was probably a boiler room, which is still quite crowded with equipment.

At the southern end of the group, the Rockeater is a relatively bulky wreck for its length compared with the frigates, and at 65 m is quite a bit larger than the fishing boats Orotava and Princess Elizabeth.

The MV Rockeater was built in New Orleans in 1945 as a coastal freighter for the United States navy. The ship was bought by Ocean Science and Engineering (South Africa) in 1964 to be used for marine prospecting.

After years of work the Rockeater was in poor condition and no longer seaworthy. It was planned to use the ship as a naval target, but because of fears that she might sink at her moorings in Simon’s Town, it was decided to

MEMBERSHIP donate her to the False Bay Conservation Society. The Rockeater was towed to Smitswinkel Bay on 15 December 1972 and scuttled.

The wreck lies upright on flat sand at about 34 m, with bows to the west.

The drilling derrick lies on the sand to the north-west of the superstructure, and the helicopter pad has collapsed to port. The rest of the vessel is largely intact but has lost a lot of superstructure plating. The hull lies on the bottom buried to what looks like near the working waterline.

‘‘

THE WRECKS OF SMITSWINKEL BAY ARE AMONG THE BESTKNOWN AND MOST POPULAR BOAT DIVES OF THE CAPE TOWN AREA.

There are a large number of openings into the wreck. On the waist deck there is a big rectangular hole in the deck plating and a number of smaller hatchways with raised coamings. There are several doors into the superstructure, and large areas of superstructure sides where the plating has wasted away almost completely, leaving only frames.

There is a lot of obscure structure on the deck, which was probably part of the drilling equipment, most of which has been removed or has collapsed.

The wrecks are too deep and dark for much seaweed, but are heavily encrusted

with invertebrates, some of which are seldom seen anywhere else but on the Smits wrecks. Reef fish are regularly seen, and some pelagic fish have been seen passing by, including oceanic sunfish and yellowtail.

EMERGENCY FACILITIES The emergency and first aid facilities available on-site for divers in Cape Town will vary depending on the operator. Check when booking whether the operator provides oxygen and other first aid materials on-site and if it has a suitable evacuation plan. Any operator registered as a DAN Diving Safety Partner will provide these services.

Metro Rescue: 10177 The Cape Town metropolitan medical response and rescue service. Call them in the event of an accident where a victim is severely injured or trapped and requires extrication or transport. Their facilities include underwater search and recovery.

National Hyperbarics (chamber): 021 671 8655 A privately funded recompression unit with specialist medical facilities for dealing with barotrauma. Call them for medical recompression problems. If you need a registered diving medical practitioner, they will be able to suggest one.

National Sea Rescue Institute: 021 449 3500 A voluntary organisation for marine search and rescue. They have several stations in the area at the V&A Waterfront, Bakoven, Hout Bay, Simon’s Town, Strandfontein and Gordon’s Bay. DAN Southern Africa 24-HOUR HOTLINE: 0800 020 111

Cape Town has some of the best emergency facilities in Africa for dealing with diving accidents, and a range of competent and efficient emergency services. AD

UNDERWATER EXPLORERS DIVE CHARTER CAPE TOWN Explore all of Cape Town’s underwater magic

Wreck Dives Reef Dives Shark Dives Seal Dives We also offer: NAUI Courses • Gear Sales • Equipment Rental • Mixed Gas Fills

CAPE TOWN’S ONLY DAN SAFETY PARTNER Autumn 2012 AlertDIVER 33 Contact Alistair: 082 873 0766 explorers@xsinet.co.za www.underwaterexplorers.co.za

TRAINING

A Safety Cornerstone Turns 20

By Brian Harper

OXYGEN EQUIPMENT HAS BEEN TRANSFORMED INTO AN IMPORTANT SAFETY TOOL THAT CAN BE EASILY USED

BY PEOPLE WITH NO MEDICAL TRAINING. THIS YEAR, DAN’S OXYGEN FIRST AID PROGRAMME CELEBRATES TWO DECADES OF IMPROVING DIVE SAFETY. .

TODAY,

oxygen is nearly ubiquitous among recreational dive businesses. It’s a pretty safe bet that any dive boat crew is trained in its use. Legions of recreational divers are certified oxygen providers and consider it a critical piece of their own gear. There was a time, though, when oxygen and capable administrators were not so common.

In 1984 Dr Arthur Dick and two of his colleagues at DAN made some interesting observations. They examined a series of decompression sickness cases from 1981 to 1982 and compared 10 cases in which divers were given first aid oxygen with 10 cases, comparable in severity, in which divers were not. First aid oxygen resulted in 90% symptom resolution during hyperbaric chamber therapy versus only 50% resolution in those who had not received oxygen prior to the chamber treatment. Recurrence of symptoms was lower in the individuals who had received first aid oxygen, and long-term outcomes were better.

Dr Dick’s study clearly established the benefits of first aid oxygen, and others, like Jim Corey at the U.S. Secret Service, began working toward making oxygen equipment safer and easier to use by people with little or no medical training. DAN Research established that, despite the benefits of first aid oxygen, only one-third of injured divers received it in an emergency.

All of these efforts made clear the necessity of an emergency oxygen training programme for the diving public. DAN spearheaded the effort in 1991 with the creation of a training department to develop and begin teaching such a programme. Dan Orr (now president of DAN) was the director of the new department. “DAN’s mission has always been about helping divers in need and promoting dive safety,” said Orr. “When the benefits of oxygen as a first aid treatment became clear, developing a means of making that accessible to divers was a natural path for DAN to take.”

Within a year of the 1991 launch of the DAN Oxygen First Aid for Scuba

AlertDIVER www.dansa.org Diver www.dansa.org 34 ALERT

Diving Accidents course, more than 1 000 divers had been trained as oxygen providers. Within another two years, the programme had gone global with the creation of International DAN (IDAN). Twenty years later, oxygen units are now considered standard safety equipment among divers, and DAN Education has trained more than 180 000 providers and thousands of instructors.

‘‘

WHEN THE BENEFITS OF OXYGEN AS A FIRST AID TREATMENT BECAME CLEAR, DEVELOPING A MEANS OF MAKING THAT ACCESSIBLE TO DIVERS WAS A NATURAL PATH FOR DAN TO TAKE.

Of course, the oxygen programme was only the first of many DAN Education offerings. Since its launch, more than a dozen training programmes have been added to the line-up, creating the most comprehensive first aid and emergency assistance training available to divers.

“It’s amazing to think that when the DAN oxygen programme started, first aid oxygen was not a universally accepted concept to divers,” said Orr. “It’s been an honour to be part of a programme that has grown to be such a cornerstone of dive safety and to know that countless divers have been helped because of it.” AD

Dive safety begins with me

TRAINING

Training Programmes Available Oxygen First Aid for Scuba Diving Injuries Advanced Oxygen First Aid for Scuba Diving Injuries On-site Neurological Assessment for Divers First Aid for Hazardous Marine Life Injuries Automated External Defibrillators for Scuba Diving Basic Life Support for Dive Professionals Diving Emergency Management Provider Programme

www.dansa.org Alert Autumn 2012 ALERT

Diver 35 DIVER

SAFETY

Chamber Profile Overview: Resort Doc

Destination:

Seychelles, Silhouette Island, Labriz Hotel

Chamber Type:

Air-filled dual lock

Treatment Type:

O2 therapy

DAN Support:

Chamber training & RCAPP

Chamber facilities in remote locations face unique challenges, but with DAN’s chamber course, attendants and operators can receive the best possible training in order to operate safely and efficiently.

Resort

Doc is a company that offers medical services to hotels and dive resorts in remote locations, such as the Seychelles, Maldives and Zanzibar. Dr Andreas Fichtner and Dr Hendrik Liedtke have a team of German doctors that offers medical emergency services at their remote clinics. Furthermore, all the doctors are trained as dive doctors and are competent to treat divers in the chambers at the different facilities.

The aim of Resort Doc is to help improve medical services in remote locations and expose European doctors to the conditions in these locations. All the doctors have a trauma background and are mentally equipped to deal with any medical situation.

Let’s focus on the Seychelles where Resort Doc has a medical and chamber facility on Silhouette Island (third largest island in the Seychelles).

Nestled between pristine shoreline and dense tropical forest, Labriz is a luxury Seychelles resort that offers guests a romantic and relaxing getaway. The island, only a 45-minute boat ride from the island Mahé (the largest island in the Seychelles), is rich in natural beauty and teeming with exotic wildlife.

The medical facility on Silhouette is there to help the local island community as well as the guests at the hotel. The doctors at the facility are able to do general check-ups, dental work and even some minor surgical procedures in the small theatre available at the facility. What makes this place unique is the fact that it has a chamber available to treat divers with decompression sickness.

Not many dive resorts are lucky enough to have their own chamber available, however, this chamber is also accessible to divers from other resorts and can easily be reached by boat from all the islands in the Seychelles. The doctors at the facility are on call 24 hours a day and work closely with the DAN hotline.

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Final “OK” after completing the pre-dive chamber checks.

The chamber itself is a dual lock and is capable of treating up to two injured divers comfortably. The chamber design is simple and easy to operate to avoid possible errors. Safety and reliability is an important feature of any chamber design and this chamber is no exception. It is important to note that the chamber is air filled and has a high-pressure bank system available to pressurise the vessel. The chamber facility does not have any advanced medical support available, but is able to provide O2 therapy to injured divers.

The chamber has two compartments, the main lock and the entry lock.

Both the entry and main lock are coated inside and outside with a special paint to avoid corrosion. The working pressure is 5.5 bars and the hull has a number of spare penetrators, which allow additional systems to be installed. The chamber also has a large medical lock as a standard feature, which allows you to lock small items into the chamber when needed. There are two view ports which allow the operator to observe both compartments while the chamber is under pressure, and maintain visual contact with the patient and the attendant at all times.

SAFETY

Let’s take a look inside the chamber: • The main chamber is accessible through the entry lock and both locks have large diameter double-hinged doors.

• All compartments have flat floorboards.

• The in- and outgoing air supply lines are protected by safety skin valves.

• The pressurisation system is provided with adequate silencers to reduce noise to an acceptable level.

• The air dump system has been constructed in such a way that it can’t be accidentally blocked by hands, clothes, etc.

• A fire extinguisher is installed in the main lock in case of a fire inside the chamber.

• An oxygen supply is available in both the main lock and the entry lock.

• Both locks have a built-in breathing system (BIBS), using overboarddump masks. This means the exhaled oxygen is discharged outside the chamber to prevent a high oxygen level inside the chamber.

• A communication system is also provided in both compartments. In case all else fails, a small hammer is available for communication by way of knocking signals.

As you can imagine, it is important to know how to operate a chamber to avoid further injury to a patient being treated. Therefore DAN has developed the chamber attendant and operator courses specifically aimed at chamber facilities in remote locations. The chamber facility receives custom-made manuals tailored to the specifications of the chamber. The training is done by one of the DAN chamber trainers under the supervision of the dive doctor at the facility. After the courses have been completed each student receives a certificate specific to the facility trained at. The most important part of the training is the practical sessions. The students need to show a suitable degree of competence in hands-on skills.

‘‘

ALL THE DOCTORS HAVE A TRAUMA BACKGROUND AND ARE MENTALLY EQUIPPED TO DEAL WITH ANY MEDICAL SITUATION.

In 2010 DAN-SA trained six chamber attendants and operators at the medical facility to assist the doctor when chamber treatments are done. The DAN chamber course is essential to ensure the safety of the staff as well as the patient, and offers adequate knowledge on how to provide basic ongoing maintenance at a remote chamber facility. More importantly, DAN is the only organisation that provides such a service to its members and their chamber facilities. The main goal of the chamber training is to ensure that the remote chamber facility is safe and able to treat divers when needed. Furthermore, DAN continues to build good relationships with the doctors at remote facilities and wants to ensure that the staff members have a good general knowledge on the basic operation of the chamber and how to maintain it.

DAN will always strive to improve the safety of scuba diving, and now the organisation has taken the next step by improving the knowledge and safety at chamber facilities worldwide. Rest assured, as a DAN member you receive professional service and have access to doctors who are experts in the field of dive medicine directly via the DAN hotline. You can imagine that with the development of the Recompression Chamber Assistance Partner Programme (RCAPP) the DAN doctors have even more confidence referring DAN members to remote chamber facilities. Proof once again that DAN is your buddy! AD

Pressurising the chamber using the inlet valve.

Autumn 2012 Alert

DIVER 37

RESEARCH

The Kids as Dolphins Project

Young breath-hold divers

DAN Research explores how breathhold diving affects children, and how their bodies adapt to exposure to hyperbaric environments.

for

a long time now, it has been observed that physiological changes experienced by our bodies in a hyperbaric atmosphere can already be experienced at just a few metres’ depth. The simple immersion of the body in water and the practice of breath-hold diving induce significant physiological changes. The famous diving reflex is an example of this.

Diving reflex or diving response

By Danilo Cialoni and Massimo Pieri

Diving reflex or diving response is a combination of reactions involving the cardiovascular and respiratory systems. It can be observed in all mammals, especially marine life (whales, seals, etc.) at the moment of putting the face underwater, and reducing the consumption of oxygen in the organism. Diving reflex is characterised by a series of reactions, such as: • Reduction of pulse, up to 50% of the usual rate.

• Peripheral vasoconstriction and the concentration of blood in certain organs, in particular in the brain and the heart.

The speed and intensity of the diving reflex is inversely proportional to the water temperature: the colder it is, the stronger the described reactions are.

Fact Diving reflex is extremely developed in cetaceans and in man (and less so in other land-living mammals) according to some studies, and supports the theory on the aquatic origins of humans – the so-called Aquatic Ape Theory.

38 AlertDIVER

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RESEARCH

If we then imagine that there are children aged between 7 and 13 carrying out this apparently simple activity, safety becomes more important and the behavioural study of their young bodies becomes not only a duty, but also a fascinating challenge that DAN Research has happily accepted with enthusiasm, making its own Diving Safety Laboratory available for this purpose.

The aim of these studies, apart from the security of young divers, is the investigation of eventual differences between adults and children and the creation of a database which will allow us to follow over a number of years how children adapt to exposure to hyperbaric environments.

DAN’s interest in this project was stimulated by the Joseph Porrino and Apnea Academy project – Kids as Dolphins – which provides guidance about diving for aspiring young divers.

‘‘

With the help of Claudio Marabotti, we followed these children for a few days, monitoring their cardiocirculatory and respiratory systems before and after dives. We also took their dental impressions.

It was a unique opportunity to collect basic data of future breath-hold divers. This perspective study is one of the most important sources for future research. Having children as the protagonists has imposed attitudes aimed at this age group.

In this light, we turned to a series of games to carry out spirometry tests and to take dental impressions. During the ecography, children were fascinated by the images that they could see for the first time: “Wow, the heart beating!”.

Claudio Marabotti got their attention, explaining in simple terms all the various examinations they were undergoing.

Study protocol

Going underwater, for a young student, should be an adventure and a learning experience.

One of the most interesting protocols was carried out to investigate what happens to the heart of a young diver. As well as the basic vital parameters, such as blood pressure, heart beat, etc., children were subjected to an echocardiogram before and after diving with a view to studying eventual changes experienced by the organ during breath-hold dives. Studies of this kind have already been carried out amongst adults, and so it should be quite

The Kids as Dolphins project “‘Acquatic adaptability’ is the keyword to use when talking about the educational project Kids as Dolphins,” says Joseph Porrino, who does not want to hear breath-hold diving mentioned when talking to young students.

The Kids as Dolphins project is aimed at children aged between 7 and 9 (for basic courses) and between 10 and 13 (for advanced courses). Young pupils are guided, through games, in the right approach to have towards the underwater environment in which safety is at the base of every single experience, and holding one’s breath is just one way of getting to know the splendid reality hidden under the sea.

Even though breath-hold dives do not last long and the depth reached is not beyond 6 m, it is very important to ensure the safety of young divers. Every two months, and for six years now, to go into more detail about this safety aspect, Joseph Porrino has been organising a conference specifically dedicated to this topic of children and diving. As Joseph told, “The aim of this project is to educate as many children as possible about prevention and the correct approach to the underwater world, to teach little ones the value of solidarity and to be well organised amongst themselves, also as a lesson which they can use in relationships in everyday life. Going underwater, for a young student, should be an adventure and a learning experience”.

Our experience in this field From 11-18 July, the Kids as Dolphins group went to the island of Elba, in Casa del Mare, a beautiful countryside residence managed by the instructor Carlo Boscia, who is responsible for social welfare projects on behalf of Apnea Academy.

Here, 23 children lived, away from their parents, for a whole week of activities dedicated to learning about the sea, with breathing and relaxation sessions, marine biology lessons, courses in marine life, learning to recognise flora, and short breath-hold dives.

Image by Morné Christou.

Autumn 2012 Alert

DIVER 39

RESEARCH easy to evaluate whether the response of a teenager (who has a hormonal condition extremely different to that of an adult) is similar or not.

This approach allows us to study children who start diving early on, and how their bodies adapt, and it also makes it possible for us to develop a unique database for following children throughout their development and perhaps even beyond that.

‘‘

THIS APPROACH ALLOWS US TO STUDY CHILDREN WHO START DIVING EARLY ON, AND HOW THEIR BODIES ADAPT.

With similar criteria, the respiratory system has also been investigated by testing basic pulmonary parameters, before and after breath-hold dives. We have already observed that a change takes place in vital functions in adults.

Finally, as a third innovative project of a dental nature, dental impressions of all children were taken and they each underwent dental examination. This study, the aim of which is to understand whether oral shape has an effect on ability to compensate, could also apply to adults. In fact, it has been observed that a large number of individuals who have problems compensating, are perfectly healthy from an otolaryngology point of view.

40 AlertDIVER

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Some preliminary studies lead to the hypothesis that in these cases, the problem could actually be of a dental nature. Therefore, young divers, for whom the bite will change over time (also for the necessary orthodontic procedures), can make for an important and unique study model.

EXCITEMENT THAT THEY WILL REMEMBER “Teacher, teacher... can I go into the water?” The voice is that of an aspiring young diver. Barely reaching the required height, armed with mask and fins, struggling to stay on the dinghy. Fighting against shivers, lips still a little purple, but he continues insisting... “Me next, me next! Teacher, I really want to have a go!”. We take him out of the water because he is feeling the cold, but he is not interested in watching the turns of his classmates, as he wants to go back and try to go back to the line. It really is incredible to see the excitement of these little children with masks on their faces, their baggy swimming costumes and their diving fins peeping out of their backpacks.

Snorkel sets in their hands, held like expert breath-hold divers, perfect turns, perfect finning actions, all fully aware of diving safety rules and all under the watchful eye of the “acquatic adaptability” instructors.

Again, we collected a large amount of data, echocardiograms before and after diving, spirometry tests and dental impressions.

Every time we think back to this weekend of research, we will think of the little one with his snorkel in hand, and the big mask on his face, continuing to shout: “Teacher, teacher, honestly, I’m not cold anymore! Can I go back to the line?”. AD

Become the operator of choice Become a DAN DSP

RESEARCH

Committed to On-Going Safety Practices Providing Professional Emergency Assistance Representing the Highest Standards in Dive Safety Recognised within the Recreational Diving Community

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DIVER 41

PRODUCTS

DAN Products PRICED TO GO!

Men’s Long Sleeve Shirt Limited stock available: 4 x Small 5 x Medium 7 x Large 4 x X-Large

Polar Fleece

Special price: R280.00

Beach Bag Ideal for those diving or beach trips when you need somewhere to keep your personal effects safe.

Special price: R106.70

Luggage Strap

Perfect for those cold winter mornings.

Limited stock available: 2 x Small 4 x Medium 3 x Large 4 x X-Large

PRICED TO GO!

Member price: R185.00 Non-member price: R200.00

PRICED TO GO! PRICED TO GO!

DAN-SA will not be replacing this product so grab it while you can!

Limited stock available: 1 x Small 4 x Medium 3 x X-Large

The DAN luggage strap helps to identify your luggage easily and keeps your items compact.

Special price: R35.00

Ladies’ Golf Shirt These new ladies’ shirts have only recently been released, and are great for the beach or as casual wear.

Limited stock available: 2 x Small 5 x Medium 10 x Large Member price: R169.05 Non-member price: R182.57 8 x X-Large Member price: R177.60 Non-member price: R191.75

AlertDIVER www.dansa.org Diver www.dansa.org 42 ALERT

Body Warmer

Special price: R157.35

Men’s Golf Shirt These new men’s shirts have only recently been released, and are great for the beach or as casual wear.

5 x Large 10 x X-Large Member price: R163.60 Non-member price: R176.70 10 x XX-Large Member price: R171.90 Non-member price: R185.65

PRODUCTS

Rescue Pack PRICED TO GO!

Ideal for shore-based diving and training activities – a complete, ready-to-use unit.

Supplied by Allied and DAN America.

Contents: - Pelican waterproof case (green) - Brass multifunction regulator - Demand valve with white O2 hose - Luxfer +/- 2.48 ℓ M9 cylinder, handwheel wrench or on/off toggle

- DAN pocket mask - Silicone Tru-fit mask - Non-rebreather mask with six-foot tubing

Member price: R5 985.00 Non-member price: R6 463.00

First Aid Kit Deluxe Plus The Deluxe Plus case is 34 x 29 x 16 cm.

Contents supplied by Levtrade.

Wound Cleaning / Management 1 x 20 mℓ irrigation syringe 1 x saline solution 10 x alcohol-free wipes Dressings / Bandaging 4 x 3.8x3.8 cm wound strips 4 x 7.6x2.5 cm wound strips 1 x 18x18 cm dressing 2 x 12x12 cm dressing 2 x eye pads 1 x 7.5 cmx4.5 m conforming gauze bandage 1 x 7.5 cmx4.5 m elastic bandage

1 x 1.25 cm adhesive tape 1 x triangular bandage Tools / Instruments / Other 1 x EMT shears 1 x disposable razor 6 x safety pins 1 x cold compress 1 x heat compress 1 x isothermic blanket 1 x infectious waste bag 1 x DAN SAM splint 1 x DAN pocket mask

Special price: R1 217.15

PRICED TO GO!

Scuba Sight Mirror Only two left!

- Identify and solve problems without having to surface - Inspect cylinder valves and hoses, do a “bubble check” or adjust a leaking mask - Spot divers above you on a crowded line - Locate a dive buddy behind or above you - Use as a signal mirror at the surface Specifications: Material: Shatterproof acrylic Size: 7.6 cm² Strap: Marine bungee cord Reflectivity: 85% - 90% Member price: R85.10 Non-member price: R100.50

Auto Shade Comes in an easy-to-store carry bag, and is ideal for wherever you may park your car.

Special price: R95.30

For more information on this product visit www.scubasight.com

ALL ORDERS CAN BE PLACED AT YOUR NEAREST DIVE SCHOOL OR WITH DAN-SA ON 0860 242 242

Alert Autumn 2012 ALERT

Diver 43 DIVER

RELAX

DAN Recipe Banana Muffins A warm baking welcome to all our members. In this issue we will be making banana muffins. We all have hectic lifestyles and to make it a little bit easier I will be giving you quick and delicious recipes in the next few issues that are easy to make and good for you.

By Sel-Marie Pereira

INGREDIENTS

4 mashed bananas 200 mℓ castor sugar 1 beaten egg 80 mℓ melted butter 375 mℓ cake flour

5 mℓ bicarbonate of soda 5 mℓ baking powder A pinch of salt Makes 12 muffins

METHOD

Preheat your oven to 180˚C. Mix the mashed bananas with the castor sugar and egg. Mix the butter with the banana mixture. Sift the flour, bicarbonate of soda, baking powder, and salt together. Pour the banana mixture into the dry ingredients and mix until just combined. Do not overmix. Pour into a muffin pan with muffin cups. Bake for ± 20 minutes. Take out of the oven, leave to cool for a few minutes and remove from pan.

DID YOU KNOW?

Bananas are a high-energy food, and are high in potassium, magnesium and vitamin B6. Bananas are ideal for divers who want to keep their energy levels up, and also allow the body to replace electrolytes and maintain fluid balance – as we know hydration is important when diving. Bananas have also been indicated to assist with hypertension and diarrhoea.

DR OCTO STICKS ‘N STONES

44 AlertDIVER

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TRAINING

DAN Training & Education Courses offered Contact a DAN instructor in your region to take any of these courses.

A full list of instructors is available from DAN-SA on 0860 242 242 or www.dansa.org under training.

Entry-level courses OXYGEN FIRST AID FOR SCUBA DIVING INJURIES

As a recreational diver, you can receive training to provide vital first aid that can make a difference to a scuba diver with decompression illness. The DAN Oxygen Provider Course provides entry-level training in the recognition and management of possible diving-related injuries using emergency oxygen first aid.

FIRST AID FOR HAZARDOUS MARINE LIFE INJURIES

Serious hazardous marine life injuries are rare. Most divers experience minor discomfort from unintentional encounters with fire coral, jellyfish and other marine creatures. This course teaches divers to minimise these injuries and reduce diver discomfort and pain.

AUTOMATED EXTERNAL DEFIBRILLATORS FOR SCUBA DIVING

More than 10% of all dive fatalities are actually caused by cardiovascular disease, according to DAN dive accident and fatality statistics. This course teaches divers and other interested parties to provide care for sudden cardiac arrest including the use of an automated external defibrillator (AED).

Intermediate courses BASIC LIFE SUPPORT FOR DIVE PROFESSIONALS

The remote nature of dive accidents, whether a few hours from shore or days from civilisation, frequently requires more advanced levels of care than are offered by traditional or entry-level CPR programmes.

ADVANCED OXYGEN FIRST AID FOR SCUBA DIVING INJURIES

(Prerequisite: Oxygen First Aid for Scuba Diving Injuries) This advanced-level programme is designed to train existing DAN oxygen providers to use the MTV-100 or a bag valve mask while providing care for a non-breathing injured diver.

Advanced courses DIVE MEDICINE FOR DIVERS

(Prerequisite: DEMP and NEURO) When you want to know more than just basic first aid techniques, Dive Medicine for Divers is your next step. Ultimately, more knowledge and a better understanding of how our bodies react to the pressures and stresses of diving lead to safer dives as we understand our limitations and the limitations of the situation.

Combination courses DIVING EMERGENCY MANAGEMENT PROVIDER PROGRAMME

Learn the knowledge and skills from several courses in one single approach to dive emergency management.

Leadership programmes INSTRUCTOR QUALIFICATION COURSE

To become a DAN instructor, you must complete the DAN Instructor Qualification Course (IQC). Instructor candidates will complete a core module that offers more information about DAN and explains how to teach DAN programmes. Candidates will then complete the course module for each DAN training programme they are interested in teaching.

ON-SITE NEUROLOGICAL ASSESSMENT FOR DIVERS

(Prerequisite: Oxygen First Aid for Scuba Diving Injuries) Learn how to conduct a neurological assessment on a potentially injured diver in this course. The information gained in this assessment can help convince a diver of the need for oxygen first aid, and help a dive physician determine the proper treatment.

INSTRUCTOR TRAINER WORKSHOP This programme teaches scuba diving instructor trainers to teach the DAN Instructor Qualification Course and train DAN instructors. Only DAN staff members and examiners can offer this programme.

Autumn 2012 Alert

DIVER 45

LISTING

DAN Business Member Directory EASTERN CAPE

INSTRUCTOR TRAINING ACADEMY 082 440 9071 • jack@sos-sa.com

Ocean Divers International • 041 581 5121

INTENSE ADVENTURES (PTY) LTD 079 876 3099 • www.intenseadventures.co.za

OUTDOOR FOCUS 046 624 4432 • www.outdoorfocus.co.za

The Dive Spot • 072 215 5668 The Water Rats • 011 958 0475 Timeout Scuba • 011 431 2963

Just Scuba • 011 452 9001/2

Turtle Divers • 011 425 3914

KYALAMI SCUBA 082 469 4699 • www.kyalamiscuba.com

TWIN PALMS SCUBA 011 454 1722 • www.twinpalms.co.za

GAUTENG

Liquid Edge Diving • 071 604 6712

Two Bar Scuba • 012 348 9078

Liquid Living • 011 467 8474

Unme Africa • 074 459 4834

2 DIVE 4 SCUBA 083 459 6492 • www.2dive4.co.za

Ment-A-Scuba • 011 973 5221

Urban Dive • 011 476 5172

Adventure n Beyond • 083 449 9819

MEYERTON SCUBA DIVING CLUB 016 362 2043 • msdc@rsn.co.za

Vertigo Scuba • 011 218 8276

Africa Bush & Dive • 012 653 6925

NAUTI-DUCK DIVERS 082 809 8353 • herrie@vodamail.co.za

Prodive PE • 041 581 1144

AHA DIVE CENTRE 012 663 3870 • www.ahadivecentre.co.za

Nautilus Dive School & Charters • 011 425 2244

Wild About Diving • 011 326 0885 Xplorer Scuba • 011 913 3529

Aqua Zoo Scuba • 011 768 6504

Nudi Divers • 083 434 6650

KWAZULU-NATAL

Aquamania • 083 236 5855

Ocean Comocean • 012 997 5374

2nd Breath Scuba Diving • 039 317 2326

Aquanuts • 011 452 3102

Ocean Dreamers • 012 345 1020

A Day In Africa • 035 571 0501

Aquatec Scuba • 072 570 8979

Oceanic Six Divers • 082 308 0205

Africa Blue • 082 574 7871

Blue Reef Dive Club • 082 453 8694

ODI PRETORIA 012 460 0746 • www.oceandivers.co.za

AGULHAS HOUSE DIVE CENTRE 039 973 1640 • www.agulhashouse.com

Peri-Peri Divers • 00 258 8255 05661

ALIWAL DIVE CHARTERS 039 973 2233 • www.aliwalshoal.co.za

BRIGHT WATER SCUBA 011 789 8686 • www.brightwaterscuba.co.za BUD & CATH’S SCUBA ACADEMY 011 609 6924 • www.fintastic.co.za

PHOENIX AQUATIC CLUB 082 425 1763 • www.phoenix-aquatic.co.za

Clear Vision Scuba • 082 374 7791

PJ’s Scuba School • 011 452 6204

Come Play Scuba Adventures • 082 416 9561

Plan D Scuba Adventures • 083 600 4007

CALYPSO DIVE USHAKA 031 332 0905 • www.calypsoushaka.co.za

Deep Blue Scuba Diving • 071 498 6913

PREST-IGE DIVE SCHOOL 011 823 4553 • www.prest-ige.co.za

Catherine’s Dive School • 031 765 5139

Deep Ocean Diving • 082 379 0778 Dive Connection • 082 444 2233 Dive With Options • 035 753 2551 Divers World School • 083 600 0181 Diving World • 011 422 3132 EAST RAND SCUBA CC 011 744 8181/0908 • www.eastrandscuba.co.za ECSTASEA DIVE SCHOOL 011 425 5426 • www.ecstasea.co.za

REEF DIVERS 012 460 9229 • www.reefdivers.co.za SANDTON SCUBA 011 463 2201 • www.sandtonscuba.co.za Scuba Fusion • 011 672 1610 Scuba Q • 011 811 4399 SCUBAVERSITY 011 958 2418 • www.scubaversity.co.za Scuba World International • 082 458 1551

Flippers To Fins Scuba Academy • 011 658 1207

Scuba.co.za • 083 645 3191

FROGGIE FEVER CC 012 347 1238 • www.froggiefever.co.za

Scuba-Licious • 011 658 1207

AMORAY DIVING 083 252 9448 • www.amoraydiving.com

Club Venture • 032 942 8014 CORAL DIVERS 035 571 0290 • www.coraldivers.co.za Da Blu Juice • 035 571 5056 DIVEDEALS SOUTHERN AFRICA 078 647 1510 • www.divedeals.co.za Diversions Adventures • 082 493 5522 DIVING IN AFRICA 039 973 2510 • www.divinginafrica.co.za Diving With Sharks • 082 256 9414 Durban Undersea Club • 031 368 1199 Gypsea Centre • 083 722 2112

Gerhard S Jansen van Vuuren • 012 991 7028

SHARED VIZ SCUBA DIVING CLUB 011 704 1259 • www.sharedvision.co.za

Getwet Diving • 082 784 2614

South Sea Adventures • 011 907 0461

In Depth Diving • 039 976 0843

Grace Diving School • 011 622 1593

Splash H2O • 011 849 5269

Let’s Scuba Dive • 031 903 4348

46 AlertDIVER

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Hydro Dive cc • 031 764 5310

LISTING

KEY:

DAN Business Member Platinum Status

DAN Business Member Gold Status

DAN Training Centre

DAN Diving Safety Partner

Meridian Dive Centre • 039 978 2403

Alan Prior • 086 111 2333

Diversity Scuba • 00 258 293 29002

MNM Diving Enterprises • 031 312 1026

ALPHA DIVE CENTRE 021 854 3150 • www.alphadivecentre.co.za

Guinjata Bay • 013 741 2795

Ocean Active Dive Charters • 031 813 5655 Ocean Vision • 072 135 1508 Offshore Africa Dive Charters • 039 976 1087 Reefteach • 082 339 6920 Scuba Addicts • 082 746 8825

Dive Action cc • 021 511 0800

Guludo Beach Lodge • 00 258 269 60536

Down South Scuba cc • 021 788 7616

JEFF’S PALM RESORT 013 932 1263 • www.jeffsmoz.com

Duck ’n Dive • 021 511 2468

LIBELULA LDA 00 258 823 066473 • www.divelibelula.com

Hippo Dive Campus • 082 923 0267 Iain’s Scuba School • 021 418 3823

Metundo Lodge Quirimbas Island • 00 258 826 223 038

Indigo Scuba Diving Centre • 083 268 1851

OCEANA DIVING 00 258 848 478110 • oceanadiving@cosmiclink.co.za

Into The Blue • 021 434 3358

Paindane Dive Charters • 00 258 489 91207

Thonga Beach Lodge • 035 474 1473

Kayak Africa • 021 783 1955

Pelago Adventure LDA • 00 258 265 00143

TRITON DIVE CHARTERS 082 494 8761 • www.tritondiving.co.za

Learn To Dive Today • 076 817 1099

Pemba Dive • 00 258 82 661 1530

Maties Underwater Club • 021 808 4678

Scuba Galaxy • 00 258 8233 38867

Old Mutual Sub Aqua Club • 021 794 3140

Simply Scuba Dive Charters • 011 678 0972

Pisces Divers • 021 782 7205

Tofo Scuba • 00 258 293 29030

African Neptune Adventures • 013 656 0426

Poseidon Diving • 044 382 3977

White Pearl Resort Ponta Mamoli • 035 592 8101

BUDDY SCUBA DIVING ADVENTURES 013 656 9303 • www.buddyscuba.co.za

Reef Divers George • 044 873 6762

Wobbegong Dive • 082 562 5738

UNDERWATER EXPLORERS 082 873 0766 • www.underwaterexplorers.co.za

Parque de Malongane • 0035 592 8103

C Crazy Adventures • 013 756 2545 Divers Deluxe • 013 656 1112

Western Cape Diving Academy • 082 486 3265

Fabsolute Scuba • 017 614 6594

INTERNATIONAL

NAMIBIA DANTICA DIVING & ADVENTURES 00 264 61 223215 • www.danticadiving.com

KENYA

SEYCHELLES Angel Fish Dive Centre • 00 248 344 133

Southern Cross Scuba • 00 254 734 601221

BIG BLUE DIVERS (PTY) LTD 00 248 261106 • www.bigbluedivers.net

MADAGASCAR Sakatia Lodge • 00 261 208 606 152

TANZANIA Blue World Diving • 00 255 777 424588

Pietersburg Dive School • 015 295 6107

MALAWI Aquanuts Dive School • 00 265 129 4026

DIVE 710 00 255 747 438668 • www.fundulagoon.com

Potch Scuba • 018 293 1930

Danforth Yachting • 00 265 99 996 0077

Diving Poseidon Ltd • 00 255 777 824427

LIMPOPO

MAURITIUS Divesail Diving Pty Ltd • 00 230 413 4224

KARAFUU DIVE CENTRE 00 255 777 413647 • www.karafuuzanzibar.com

Sea Urchin Ltd • 00 230 453 8825

ONE OCEAN THE ZANZIBAR DIVE CENTRE 00 255 2422 38374 • www.zanzibaroneocean.com

Scuba Club • 031 701 4896 SODWANA BAY LODGE SCUBA CENTRE 035 571 0117 • www.sodwanadiving.co.za

Zululand Undersea Club • 035 753 1212

MPUMALANGA

Get Wet Scuba • 013 656 5158 IANTD (SA) 082 650 2294 • www.iantd.co.za Scuba Rebels • 013 235 4366

NORTH WEST

Fins n Boots • 015 291 2597

FREE STATE Bloemfontein Sub Aqua Club • 072 070 9233

WESTERN CAPE

Buccaneer Diving • 00 254 41 41 4439

MOZAMBIQUE Azura Retreat @ Gabriels • 00 258 293 84087 BARRA LODGE 00 258 820 94 1890 • www.barraresorts.co.za Barra Reef Divers • 00 258 293 56035 Blue Footprints Eco Lodge • 00 258 848 900 507

34 South Divers • 072 437 5762

Dive Morrungulo • 00 258 847 16661

African Waters Scuba • 041 360 4653

Divers Eco Operation LDA • 00 256 778 695 824

Pleasure Blay Watersport Centre • 00 258 293 56433

O’Willies Scuba Diving Safaris • 00 255 776 481169 Paje East Coast Diving • 00 255 777 416614 Ras Nungwi Beach Hotel • 00 255 242 233767 Rising Sun Dive Centre • 00 255 777 811274 Tanga Adventures • 00 255 786 665991 Unguja Lodge Ltd • 00 255 0774 477 477

Autumn 2012 Alert

DIVER 47

TEAM

In a dive

emergency

CALL

DIVER

Alert

CEO Medical Director Assistant Medical Director Special Projects and Marketing/ DAN DSP Co-ordinator Hotline Support DAN Membership Administrator Membership Services Assistant Medical Officers

TOLL FREE

0800 020 111

from INSIDE South Africa OR

DesignWrite www.designwrite.co.za

Publisher

DAN Southern Africa

Additional Contributors

Alistair Downing Brian Harper Cormac McCreesh DAN Medical Team DAN Team Danilo Cialoni Lee Griffiths Mark van Coller Massimo Pieri

from OUTSIDE South Africa

VISION Striving to make every dive, accident- and injury-free. DAN’s vision is to be the most recognised and trusted organisation worldwide in the fields of recreational diver safety and emergency services, health, research, and education by its members, instructors, sponsors, and recreational diving community at large.

DAN PUBLICATION PHILOSOPHY Alert Diver Southern Africa is a forum for ideas and information relative to dive safety, education and practice. Any material relating to dive safety or dive medicine is considered for publication. Ideas, comments and support are encouraged and appreciated.

The views expressed by contributors are not necessarily those advocated by DAN. While every effort is made to ensure the accuracy of information and reports in the Alert Diver Southern Africa, the publisher does not accept any responsibility, whatsoever, for any errors, omissions, or for any effects resulting therefrom. As to the best of the publisher’s knowledge, contributors have not indulged in plagiarism. Although the utmost is done to avoid such occurrences, the publisher will not be held responsible for the contributors’ or writers’ indulgence in plagiarism. No part of this publication may be used or reproduced in any form, without the written permission of the publisher.

DAN is a neutral public service organisation that attempts to interact with all diving-related organisations or persons with equal deference.

Alert Diver Southern Africa is published for the diving public, and is not a medical journal. The use and dosage of any medication by a diver should be taken under the supervision of his/her physician. Alert Diver Southern Africa is a biannual publication, published by Divers Alert Network Southern Africa, DAN Building, Rosen Office Park, Cnr Invicta and Third Roads, Halfway Gardens, Midrand, South Africa.

SUBMISSIONS Submissions of articles and photographs for publication are welcome, but the publisher, while exercising all reasonable care, cannot be held responsible for any loss or damage. All due care will be taken with submitted material. Alert Diver assumes no responsibility to return unsolicited editorial or graphic material. All material will be subjected to Alert Diver ’s unrestricted right to edit any submission received, and the owner thereby consents that the publisher may publish the material in any other media as deemed necessary. Please ensure that your material is sent to altertdiversa@dansa.org or to Alert Diver Magazine, Private Bag x 197, Halfway House 1685.

Images should be 300 DPI and should be accompanied by a caption and the name of the photographer. Copyright © 2012 by Divers Alert Network Southern Africa. All rights reserved.

AlertDIVER www.dansa.org Diver www.dansa.org 48 ALERT

Morné Christou Dawn Avice du Buisson Sel-Marie Pereira Toni Krige-McQuillen Dr Cecilia Roberts Dr Gary Morris Dr Isabel Reader Dr Louis van Heerden Dr Lourens de Kock Dr Mike Marshall Dr Rob Schneider

Editorial Management, Quality Assurance, Layout & Production

+27 828 10 60 10 +27 10 209 8112

MISSION The primary mission of DAN, a non-profit organisation, is to provide emergency medical advice and assistance for underwater diving injuries, to work to prevent injuries and to promote dive safety. Second, DAN promotes and supports underwater diving research and education particularly as it relates to the improvement of dive safety, medical treatment and first aid. Third, DAN strives to provide the most accurate, up-to-date and unbiased information on issues of common concern to the diving public, primarily, but not exclusively, for dive safety. DAN is your dive safety association.

Francois Burman Dr Jack Meintjes Dr Hermie Britz

International Contact details DAN AMERICA (INTERNATIONAL HEADQUARTERS) 1-800-446-2671 Toll-Free +1-919-684-2948 General Inquiries +1-919-490-6630 Fax +1-919-493-3040 Medical Fax Diving Emergencies DAN America +1-919-684-9111 +1-919-684-4326 (accepts collect calls) DAN Latin America +1-919-684-9111 (accepts collect calls) Non-Diving Emergencies & TravelAssist Services 1-800-326-3822 (1-800-DAN-EVAC) +1-919-684-3483 (Call collect if outside the USA, Canada, Puerto Rico, Bahamas, British or U.S. Virgin Islands) DAN EUROPE +39-085-893-0333 +39-085-893-0050 Fax Diving Emergencies DAN Europe +39-06-4211-8685

DAN JAPAN +81-45-228-3066 +81-45-228-3063 Fax Diving Emergencies DAN Japan +81-3-3812-4999 DAN ASIA-PACIFIC +61-3-9886-9166 +61-3-9886-9155 Fax Diving Emergencies DES Australia 1-800-088-200 (within Australia) +61-8-8212-9242 (outside Australia) DAN / DES New Zealand 0800-4DES111 Singapore Naval Medicine & Hyperbaric Center 6758-1733 DAN Asia-Pacific - Philippines (02) 632-1077 DAN Asia-Pacific - Malaysia (05) 681-9485 DAN Asia-Pacific - Korea (010) 4500-9113 DAN Asia-Pacific - China +852-3611-7326

Dynamic Training

PARTING SHOT

Parting Shot gives you a chance to share your interesting dive stories and images with us.

Have you encountered a rare or exciting activity underwater and captured it? Has an underwater event just added that something extra to your dive and you have a photo? If so, all you have to do is send through your high resolution image (300 DPI) along with your story (including a brief description of your creature, location of dive site and pertinent photo information) and contact details to partingshot@ dansa.org and your submission could appear in the next edition of Alert Diver!

All images submitted for the Parting Shot become the property of DAN.

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DAN member Mark van Coller submitted this edition’s Parting Shot. This is his story:

An early morning training session at the Sea Point public swimming pool in Cape Town as freediver Sophia van Coller trains for the Dynamic with Fins discipline in freediving. The freediver has to swim as far as possible underwater on a single breath and finish the swim with the correct surface protocol in order for the distance to be official. The current women’s SA record is 150 m, which Sophia is trying to break. This picture was taken with a Canon 5D MKII in a Subal housing, with an 8 inch dome port to get the split level effect.

Alert Autumn 2012 ALERT

Diver 49 DIVER

Whatever your diving journey, DAN is with you every step of the way.

www.dansa.org