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FIRST AID FOR DIVERS

Student Notes

Skill Development Course BSAC First Aid for Diver Course Manual

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Š BSAC Thailand 7/2009

THE BRITISH SUB AQUA CLUB

1


FIRST AID FOR DIVERS

Student Notes

SKILL DEVELOPMENT COURSE BSAC FIRST AID FOR DIVERS

STUDENT NOTES

British Sub-Aqua Club, BSAC Thailand 9/ 33 Post Office Road, Mae Haad, Koh Tao, Koh Phangan, Surratthani, 84360, Thailand Tel: 0860589408 Fax: +66 (0)77 456782 www.bsacthailand.com

info@bsacthailand.com

All rights reserved. This Instructor Manual may not, in whole or part, be copied, photocopied, reproduced or translated, or converted into any electronic or readable form without prior written consent of British Sub-Aqua Club

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2


FIRST AID FOR DIVERS

Student Notes

FIRST AID FOR DIVERS COURSE AIMS To teach the basics of First Aid likely to be needed in the sports diving environment and making use of the recourses likely to be available at the time. This will include the improvisation of dressing, splints etc using materials and equipment commonly available on the dive site or in the boat. PRINCIPLES AND PRIORITIES OF FIRST AID What is First Aid? The application of accepted principles of treatment on the occurrence of any injury or sudden illness, using facilities or materials available at the time. Propose of First Aid To do the minimum necessary to:   

preserve life limit the effects of the condition promote recovery

The First Aider Role and Responsibilities     

assess the situation diagnose what is wrong give appropriately prioritised treatment remain with the casualty until the casualty is either evacuated to medical attention or is fully recovered responsibility ends when the casualty is handed over to medical personnel and a report given

Priorities Assessing the situation     

be calm and take charge ensure the safety of yourself and the casualty guard against further casualties reassure the casualty get others to help

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3


FIRST AID FOR DIVERS

Student Notes

Diagnosis  incident history  signs  symptoms Priorities of Treatment Preserve life Basic Life Support   

adequate airways (A) adequate breathing (B) adequate circulation (C)

Control bleeding Limit the effects of the condition    

treat for shock dress the wounds immobilise large wounds and fractures comfortable position Promote recovery

    

reassure casualty relieve the pain handle casualty gently keep casualty warm arrange for evacuation to medical aid Multiple Casualties Priorities 1 - non-breathing casualties airways and resuscitation 2 - unconscious breathing casualties / recovery position 3 - severe bleeding

  

identify and treat most serious condition treat others as circumstances allow noisiest casualty is rarely the most seriously injured

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4


FIRST AID FOR DIVERS

Student Notes

Hygiene  Major injuries – saving life is the priority, worry about infections later  Minor injuries – cleanliness essential to prevent a minor problem being aggravated by infection First Aid considerations:        

body ody fluids have the potential to be infectious emotion should not be allowed to blow the potential risk of infection out of proportion infections need a means of entry whole skin is an effective barrier; as an added precaution, if possible, wear disposable gloves if in contact with body fluids wash with soap and water clean up spilt body fluids with household bleach any perceived risks should not discourage First Aid post st event checks for possible exposure are available if in any doubt

BASIC LIFE SUPPORT (BLS) REVIEW In water life support sequence

BLS on land Continue Basic Life Support at a ratio of 2 breaths every 30 seconds until assistance arrives. arrives Share first aid duties if more than one operator

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5


FIRST AID FOR DIVERS

Student Notes

● If it has not already happened, the rescuer needs to arrange for someone to contact the emergency services ● The rescuer should remain with the casualty and continue first aid. When the emergency services arrive they should be given all details of the incident and first aid given No two rescues will be the same. The likelihood is that there will be other divers able to render assistance from an early stage in the rescue. Whatever a rescuer does they will, by force of circumstance, have to compromise to achieve the best they can at the time. Because of the stress and exertion involved in a rescue, the more qualified assistance there is, such as good surface support, the more they can help and assist the rescuer as soon as possible. CASUALTY EXAMINATION Assess and record:  history  responsiveness – sight, speech  symptoms – information from the casualty  physical examination -

minimal movement of the patient head to toe sequence compare both sides of the casualty’s body

Head Skull – swelling, indentations Face – colour, skin, temperature, breathing Eyes – pupil size, response to light Ears – hearing, blood, fluids Nose – appearance, blood, fluid Mouth – breathing, odour, wounds, irregularity, discolouration

Neck – loosen clothing, warning medallions, vertebrate, tenderness, bruising

Trunk – chest movement, symmetrical collar bones and ribs, wounds, tenderness, incontinence

Back and Spine – vertebrate, swelling, tenderness

Upper limbs - check movement , bruising, swelling, deformity, warning bracelet, feeling

Lower limbs – check movement, bruising, swelling, deformity, feeling

Feet – movement, feeling, colour deformity

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6


FIRST AID FOR DIVERS

Student Notes

SUMMONING ASSISTANCE Diving Incident Coastguard  

VHF Radio – channel 16 (PAN PAN Medico) 999/911 Telephone

Royal Navy (UK)   

Telephone 0831 151523, Duty Diving Medical Officer’s mobile number State that you have a diving emergency The Duty Diving Medical Officer will: give you medical advice advice of the location of the nearest recompression facilities advice on relevant telephone numbers He will not be able to: -

arrange transport advise of the availability of the recompression facility

It is the diving party’s responsibility to: -

contact the recompression facilities establish which facility can accept the casualty arrange for casualty evacuation via the local emergency services

Have details ready to give to the Coastguard / Duty Diving Medical Officer and go with the casualty to the medical facility: -

dive history description of signs and symptoms and when they occurred details of any First Aid given (e.g. Oxygen administration etc)

Non-diving incident Ambulance service -

telephone 999/911 call give clear and concise details of the incident give clear and concise details of the dive location ensure that the person making the call report back to the First Aider Have the relevant information ready for the arrival of the medical aid

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7


FIRST AID FOR DIVERS

Student Notes

SHOCK Definition Inadequate circulation leading to tissue damage due to inadequate tissue oxygenation and waste removal Mechanism and causes Reduced blood volume (Hypovolaemic Shock)    

massive bleeding plasma loss due to burns plasma loss due to bruising prolonged seasickness

Massive dilation of the blood vessels (Low Resistance Shock)  

fainting hyperthermia

Inadequate cardiac output (Cardiogenic Shock)  

heart Attack pulmonary barotrauma

Allergic reactions (Anaphylactic Shock) – drugs, food, stings etc Long period of immersion (Immersion Shock) - Removal from the water – keep casualty horizontal Signs and Symptoms         

casualty feels weak, faint and giddy casualty is anxious and restless casualty may feel nauseous and vomit casualty may feel thirsty pale, cold clammy skin profuse sweating rapid shallow breathing, yawning and sighing rapid weak pulse unconsciousness

First Aid measures   

treat the prime cause keep the casualty quiet and reassured lay casualty down with legs raised (not if DCI burst lungs is involved)

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8


FIRST AID FOR DIVERS    

Student Notes

keep eep casualty warm and comfortable (DO NOT apply heat) administrate 100% oxygen nothing by mouth, moisten lips only evacuate to medical attention

WOUNDS AND BLEEDING Wounds Definition:   

any damage to the skin or underlying tissues an ‘open’ wound is where the skin is breached a ‘closed’ wound occurs to underlying tissue beneath the whole skin

Types of Wound:

B

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9


FIRST AID FOR DIVERS

Student Notes

Bleeding The body responds to bleeding by:  Blood clotting  Contraction of the blood vessels at the site of the wound Platelets

Fibrin Thread

Blood Clot

General First Aid Aims:  minimise blood loss  help body cope with blood loss  treat for shock

Control bleeding by:  direct pressure  indirect pressure at pressure point (release every 10 minutes)  elevation of the effective area  DO NOT use tourniquets

Pressure Points Definition: 

a point where an artery presses over an underlying bone while close to the surface of the skin

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10


FIRST AID FOR DIVERS

Student Notes

Locations: Temporal Carotid Subclavian Brachial Radial

Femoral

Ulnar

Popliteal

Pressure Points held for no more than 10 minutes Open wounds Open First aid for severe bleeding  apply pressure (directly or indirectly as appropriate) to control bleeding  raise and support the injured part  if dressing is inadequate apply further dressing on top-do NOT remove existing dressing  bandage firmly over dressing  immobilise affected area to prevent disturbance of blood clotting First Aid for minor bleeding  cleanse wound  dry wound  apply sterile dressing  apply firm bandage  check circulation downstream of wound Internal Bleeding Signs and symptoms pdfMachine Page Is a pdf writer that produces quality PDF files with ease! Produce quality PDF files in seconds and preserve the integrity of your original documents. Compatible across nearly all Windows platforms, if you can print from a windows application you can use pdfMachine. Get yours now!

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11


FIRST AID FOR DIVERS

Student Notes

Signs of shock without obvious blood loss         

pallor cold , clammy, pale skin rapid weak pulse thirst confusion, restlessness, irritability collapse, unconsciousness pain and tenderness totally out of proportion to extent of visible damage pattern bruising coughing / spitting blood of blood in faeces or urine

First Aid treatment  

lie casualty down with legs raised arrange urgent removal to medical care

Check and record condition at 10 minute intervals - breathing - pulse - level of response - If casualty looses consciousness, place them in the recovery position

BURNS Types of burns Dry burns    

flames hot engine exhaust ‘rope burns’ electrical burns

Scalds  

hot water steam

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12


FIRST AID FOR DIVERS

Student Notes

Chemical burns 

Acids (e.g. boat engine batteries)

Classification: Area   

1% or more of the body surface area affected will need medical attention The area of the hand is approximately 1% of the body surface area 9% or more of the body area will need hospitalization

Wallace’s rule of nine’s        

head upper chest upper back arm (each)) abdomen lower back thigh (each) lower leg (each)

9% 9% 9% 9% 9% 9% 9% 9%

Depth Superficial – outer layer of skin only   

redness swelling extreme tenderness

Partial – thickness – can be infected  

blisters surrounding area swollen and red

Full- thickness – relatively pain free due to damaged nerves  

skin kin appears waxy and pale sometime charring

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13


FIRST AID FOR DIVERS

Student Notes

Signs and symptoms     

severe pain at the sight of injury numbness if a deep burn sometimes blistering grey, charred, peeling skin shock

Electrical burns   

superficial surface injury extensive damage to lower layers Cardiac Arrest?

General treatment – superficial burns and scalds  

  

reassure the casualty cool the affected area - gently running cold water - 10 minutes minimum remove constrictions before swelling starts protect the affected area DO NOT : - break blisters – natures natural protection - apply lotions, ointments etc - use adhesive dressings

General treatment – partial and full thickness burns Note: for electrical burns ensure electricity supply is disconnected         

lay casualty down gently remove constriction before swelling starts Carefully remove fluid soaked clothing, DO NOT remove dry clothing use unmedicated sterile dressings immobilize badly burned limbs treat for shock If Conscious, give frequent sips of cold water recovery position evacuate to medical attention if burns are greater than 1% of body surface area

General treatment – chemical burns 

flood the affected part with water

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14


FIRST AID FOR DIVERS

Student Notes

flood for a minimum of 10 minutes ensure water drains clear of the unaffected areas gently remove contaminated clothing avoid spreading the contamination avoid self contamination continue as for partial and full thickness burns

     

MISCELENAEOUS INJURIES Mask squeeze Cause 

Inadequate equalization of the mask volume on decent

Signs  

bruised/swollen ed/swollen facial tissue bruised ruised haemorrhaged eyes

First Aid treatment    

self healing reassurance medical edical attention if painful casualty asualty should reframe from diving until clear and taught how to prevent a recurrence

EAR PROBLEMS Structure

Causes  

Inadequate ear clearing on decent Tight hood on decent

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15


FIRST AID FOR DIVERS 

Student Notes

Blocked Eustachian tube on ascent

Sign and symptoms     

pain – which maybe suddenly reduce giddiness/vertigo hearing disturbances – tinnitus deafness possible bleeding from the ear

First Aid treatment    

cover the ear with a sterile dressing place head in an attitude that allows the blood to drain out of the ear obtain medical attention refrain from diving until cleared by a doctor to resume

SINUSES Frontal

Ethmoidal

Cause 

Blocked entry to sinus

Signs and symptoms  

acute pain in the affected area possible blood discharge from nose Maxillary

First Aid Treatment   

no direct first aid possible pain killers medical aid in serve cases

TEETH Causes  

air pockets trapped behind fillings cavities with narrow openings

Signs and symptoms

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16


FIRST AID FOR DIVERS

Student Notes

sensitivity/pain ensitivity/pain in tooth during ascent and /or descent se dislodged filling /split tooth possible bleeding from the gum

  

First Aid Treatment  

for or pain only, refer casualty to dentist for rectification of cavity before further diving for damage to tooth /bleeding, place pad to prevent contact of injured area with other teeth and evacuate to o medical attention

BLAST INJURY Causes   

exploding cylinder burst (failing hose) explosives - extremely unlikely in SPORT diving

Injuries in air can be very dramatic. Underwater can produce profound internal damage with little or no visible injuries Injuries are due to:     

Injuries overpressure bruising separation between adjacent tissues soft tissue damage limbs damaged or amputation

Shrapnel    

high igh velocity /energy particles possible multiple wounds small entry wounds / serve underlying tissue damage major organ damage

First Aid treatment      

no specific treatment – combined normal First Aid actions for various types of injury counter bleeding treat fractures make casualty comfortable treat for shock arrange for medical attention at the earliest point that priorities dictate

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17


FIRST AID FOR DIVERS

Student Notes

SEASICKNESS Cause effect ffect of motion on balance mechanism frequency and nature of the motion affect people different

 

Prevention /minimization diet location in the boat visual horizon constrictions anti-seasickness seasickness measures measures- tables, pads, wristbands, adaptation different ifferent motion once in the water

     

Signs and symptoms nausea pallor vomiting headache loss of co-ordination casualty asualty becomes irrational

     

Treatment lay /sit casualty down keep warm secure ecure casualty to prevent injury or from falling overboard remove emove to stable environment

   

HYPOTHERMIA Definition   

body ody temperature drops below 35 C moderate oderate hypothermia recovery ecovery is unlikely when the body temperature has fallen below 26-24 C

Cause 

Inadequate protection against a cold environment

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18


FIRST AID FOR DIVERS

Student Notes

water ater conducts heat 25 times faster than air wind chill /evaporation

 

Signs and symptoms Treatment         

insulation, nsulation, around and underneath the casualty lay ay casualty down, keep quiet place lace casualty in the recovery position if unconscious keep hand and arms away from direct contact with the body trunk place in a warm sheltered environment replace or cover wet clothing administrate hot sweet drinks BLS if required evacuate to medical attention

Do not:   

give ive the casualty alcohol rub or massage the casualty limbs allow the casualty to perform any exercise

In extreme circumstances where medical aid is not available:  

Apply GENTLE heat to the bod body trunk, not to the extremities Aim to re-warm warm at the same rate that the body was originally cooled

HYPERTHERMIA Heat exhaustion is the aspect of hyperthermia most likely to be encountered in the UK. Other aspects of hyperthermia, such as heat stroke, a are re only likely to be encountered in hot climates. They are not covered in this course when it is run in the UK. Causes    

exercise xercise in warm climates, e.g. on diving holiday in the Tropics overheating in the UK summer temperatures when wearing dry suit, particularly when involved in heavy exercise sweating results in loss of salt from the body aggravated by stomach upset with diarrhea and vomiting

Signs and symptoms 

casualty asualty feels exhausted and restless

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19


FIRST AID FOR DIVERS     

Student Notes

headache, dizziness, nausea muscular cramps in lower limbs pale face, cold clammy skin breathing fast and shallow, pulse rapid and weak temperature normal or falls

Treatment     

lay casualty down in a cool place if conscious give slips of cold water if sweating profusely, diarrhea and /or vomiting give half a teaspoonful of salt to each litre of water place in recovery position if unconscious evacuate to medical aid

Exhaustion Cause  

overexertion aggravated by heat, cold, depth illness

Signs and symptoms    

deep labored breathing headache confusion body unable to respond, either physically or mentally, to the demands placed upon it

First Aid Treatment    

cease physical activity lay casualty down keep casualty quiet if underwater - settle on a stationary object - regain control of breathing - control buoyant ascent - provide surface buoyancy - assist from the water

Exhaustion is a common indicator of decompression sickness

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20


FIRST AID FOR DIVERS

Student Notes

INJURIES TO MUSCLES, BONES AND JOINTS The skeleton   

Provides support to the body tissues Protects the major organs Enable moment

The muscles  Cause movement  Operate vital functions - respiration - circulation Strains Definition – overstretching of a muscle Signs and symptoms  

sudden udden sharp pains at the site of injury swelling welling in limb muscle muscles

Sprain Definition – wrenching or tearing of ligaments or tissue at a joint Sign and symptoms    

pain at joint swelling bruising ruising and discolouration (later) inability nability to move joint without pain

First Aid Treatment of strains and sprains    

R – rest, supported in the most comfortable position I – ice bag or cold water compress C - compression with cotton wool and bandage E – elevation of the injured area and evacuate to medical aid

FRACTURES Definition – broken or cracked bone

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21


FIRST AID FOR DIVERS

Student Notes

Causes Indirect Force

Direct Force

Muscle contraction

Types Closed Fracture – Broken bone under the skin Open Fractures – Bone protruding through the skin 

Associated, organs, tissue, nerve or blood vessel

Sign and symptoms         

sound visible bone ends pain deformity crepitus tenderness enderness to gentle pressure swelling / bruising loss of power to the limb shock

General rules for treatment  

rarely life threatening immobilize where lay

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22


FIRST AID FOR DIVERS        

Student Notes

steadily until splinted gentle entle traction above and below break support upport in the most comfortable position dress ress open fracture before splinting transport ransport slowly and deliberately don’t on’t miss other less obvious condition conditions treat for shock nothing by mouth

Practical considerations  

   

Uninjured limbs make good splints Splint - sufficient rigidity - sufficient length padding use natural hollows tie ie knots on uninjured side or against splints don’t bind too tightly - impedes circulation - allow for swelling - raise aise injury if possible – minimizes bleeding / swelling

Dislocation Definition – displacement of one or more bones at a joint

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23


FIRST AID FOR DIVERS

Student Notes

Sign and symptoms    

pain fixity of joint deformity /abnormal appearance of joint swelling and bruising

First Aid Treatment   

support in the most comfortable position refer to medical aid DO NOT attempt to reset the joint May accompany a fracture – if in doubt treat as a fracture

FIRST AID KIT Small boat kit    

2 - large sterile dressings 2 – triangle bandages rescue blanket or large polyphone bag several safety pins

Items should be individually wrapped in sealed plastic bags. The whole kit should be housed in a waterproof container Supplement kit by improvisation using boat equipment and diving kit Dive Marshal’s Kit Contents            

First aid instructions 6 each, small, medium and large standard dressing Large pack of assorted adhesive dressing 4 large triangle bandages 50 mm crepe bandage 10 assorted safety pins 3 - 50 mm of roller bandages Roll of 25 mm zinc oxide plaster Scissors, tweezers Pack of sterile cotton wool Disposable gloves and a rescue blanket / plastic bag

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24


FIRST AID FOR DIVERS

Student Notes

BSAC SKILL DEVELOPMENT COURSES (SDC’s) www.bsacthailand.com

info@bsacthailand.com

If you enjoyed this course why not try one of the following courses; available from any of our BSAC Dive Centres

Rescue Courses -

Oxygen Administrator First Aid for Divers Rescue Manager Lifesaver Award Advanced Lifesaver Award

Seamanship Courses - Powerboat Handling for Divers - Dive site location and Surface Navigation (Chart work and Position Fixing) - Diver Coxswain Award - Outboard Engine Maintenance

Technical Diving Courses -

Deep Air Diver Nitrox Diver Combined Advanced Nitrox Extended Range Diving Gas Blender Compressor Management Full Face Mask Equipment Care

Other Specialized Courses - Buoyancy Workshop - Digital Underwater Photography - Pro - Videographer - Dive Site Mapping

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25


First aid for divers