Your DAN Safety Stop 2019 Q2

Throughout it’s history, DAN has led the movement to promote diver health and safety, actively campaigning industry stakeholders and engaging communities around the world to advance safe practices. During this time almost every facet of recreational diving has evolved... it’s now time to evolve how the industry responds to dive incidents.

We are taking the next step and working directly with you to offer the education, training and resources needed to build safer dive communities around the world.

Through new and utilising existing programs, services and resources, DAN has developed a modern, multifaceted approach to preventing and responding to emergencies.

DAN’s medical services are available to recreational divers, dive professionals and health-care providers of every level. We offer physician education, an emergency hotline, medical information and consultation, educational programs and a worldwide referral network of doctors who treat or evaluate divers. The DAN Emergency Hotline is staffed by doctors, nurses, paramedics and emergency medical technicians who are on call 24 hours a day, 365 days a year to provide information, coordinate care and facilitate evacuations.

We get the call. It might be from a diver, a traveler, a friend or a physician. But regardless, someone needs medical attention and they need our help. DAN medics are on call 24/7 ready to assist and can engage with our on-call physician if needed.

An immediate course of action is recommended, including first-aid if needed. If local emergency medical services (EMS) has yet to be activated, the caller is instructed to do so.

A protocol for staying in contact is established. The DAN medic and the caller work together to make a plan to get the patient necessary medical care.

Not all injuries can be treated locally. If evacuation is required, DAN organises an emergency evacuation to ensure the patient receives necessary care.

Throughout the incident, the DAN team remains in contact with the caller and patient, inquiring about the patient’s condition, providing updates regarding evacuation, and remaining available to provide support.

Maintaining frequent contact, the DAN team monitors definitive care and medical evacuation progress. If insured, DAN’s insurance professionals join the patient’s support team.

From the time we get the call until the patient is discharged, DAN is there. Whether you’re a diver, a traveler or both, we’re here for you.

Phew!  This year is going by faster than anybody can say 3..2…1…go!

After lazing about at the Port Elizabeth dive festival things just picked up speed. Nicky Olckers one of the DAN representatives was fortunate to have the opportunity to visit Nosy Be (Madagascar) and stay at Sakatia Lodge. She was extravagantly spoiled with diving on most days and taken to see some of the tourist sites around Nosy. The water was clear and the seas flat that made for excellent diving. She received world class treatment during her stay at Sakatia Lodge. The main reason for her visit was to promote the different DAN services and build stronger relationships with the dive industry. The DAN workshop at the chamber facility was well supported by the Nosy Be dive industry and finished with a dry dive under control by Jose Vieira from Sakatia Lodge who maintains the chamber facility. After her return to South Africa Nicky spent some time at the DAN office in Johannesburg before catching up on her Social Media duties that helps spread DAN awareness.

Life happens… While learning to dive is relatively safe, there are inherent risks. From minor injuries such as ear issues or a slip-and-fall to more serious dive related injuries, this coverage helps ensure new divers can learn confidently knowing they are protected.

Some health insurance plans exclude coverage for adventure sport and scuba diving injuries. Others may have large deductibles or co-pays for treatment. DAN’s program pays 100% of covered medical expenses.

As entry-level divers, students are often not aware of all the safety aspects and possible risks associated with diving. To cater specifically for these needs, DAN has developed the Student membership package. Instructors can ensure their students are safe from their very first breath as divers.

Why do entry-level students’ divers need cover? Instructors have asked why students should have DAN cover since they are not exposed to the same diving risks as certified divers. DAN offers (complementary) cover to student divers because their risk is indeed much lower. However, injuries can still occur during instruction. In fact, according to DAN’s annual report on Decompression Illness and Diving Fatalities, student injuries have been the third and fourth leading diving activity associated with diving injuries during the past several years.

Did you know that the entry-level dive cover is free? Yes it is true! As long as the instructor is an active DAN member. DAN Student membership offers entry-level divers’ emergency medical benefits for the duration of their entry-level training. It provides up to R300,000 emergency medical service benefits at no cost to the diver or the instructor who teaches them. It is about providing peace of mind to students and instructors alike.

How are students enrolled? Instructors need to sign up their students at the beginning of a course. Instructors can apply online or even download the application form for the Student Membership from the DAN website or use the DAN mobile App available via the Google Play Store or the Apple App Store. Upon qualifying, we hope that newly-certified divers will realise the benefits of becoming full DAN members. Upon receipt of a student’s registration, both the student and the instructor will receive, via email, a confirmation of registration and the student’s new student member number.

Kudos to the following dive instructors that made use of the Student membership programme on a regular bases during the past months. We take note and recognise their consistent work.

• Elton Polly from Go Dive Mosselbay,
• Reel van der Merwe, Gardenroute scuba,
• Keith Henderson, 2Dive4 scuba,
• Stephen Berriman, Spalsh H2O
• Jaco de Klerk,
• Chris Steenkamp, Dantica Diving Windhoek,
• Cholo Mkubwa, Fun Divers Zanzibar,
• Clare from Aliwal shoal dive Charters

To name but a few. To all of the dive instructors in the DAN Southern Africa region,  thank you for introducing your students to diving and doing it as safe divers. Remember it is Your Adventure! Your Safety!

Another first for Nicky was visiting Mauritius. She was introduced to this super friendly dive destination on arrival. Through several meetings with the members of the Mauritius Scuba Diving Association (MSDA) she was able to make new friends and partnerships on the Island. The lively bunch from Mauritius underwater Group had a lot of questions and a super welcoming BRAAI (Barbecue)!

At present Nicky is visiting many of the dive resorts along the Mozambican coastline. After she returns from Mozambique she will make a quick stopover at the DAN office before traveling to Zanzibar at the end of August to continue growing DAN awareness and fostering relationships with the local dive industry.

IN PREPARATION FOR YOUR NEXT DIVING HOLIDAY, DAN HAS DEVISED A FEW HELPFUL TRAVEL SAFETY TIPS TO ENSURE YOU MAKE THE MOST OUT OF YOUR TRIP.

As DAN members embark on their dive getaways for the holidays, there are important safety tips every diver needs to take into consideration. We present these tips, adding our own DAN twist to a few pointers mentioned in Baz Luhrmann’s ever-popular sunscreen song, “Everybody’s Free (to Wear Sunscreen)”.

Use sunscreen: The long-term benefits of sunscreen have been proven by scientists.

Enjoy your youth: Dive, travel and dive some more, and become oblivious to the wrinkles you may imprint from squinting into the sun and from the salty water. Trust us, when your youth has faded, you’ll look back at photos and fondly recall each twinge of excitement you felt, grasping onto the hopes of seeing that whale shark, coelacanth, dugong or great white.

Don’t worry: DAN is your buddy. Be sure to check that your membership status is active and keep the DAN hotline number handy for medical advice, which is available 24/7/365 worldwide. Don’t forget to activate roaming on your cell phone.

Don’t be reckless: Don’t put up with people who are reckless with your life. Stretch: Rest after a dive, relax and take in the breeze… ah, enjoy life!

Travel: Don’t feel guilty to travel the world and dive in exotic places.

Be kind to your knees: Keep in shape and be fit for that swim in the ocean current. Have your regular check-ups with your dive physician, and follow his or her advice with regard to medication and diving.

Read the map directions: Familiarise yourself with your surroundings and what emergency resources are available in the area. Choose a DAN Dive Safety Partner as your guide.

Accept certain inalienable truths: Never bolt to the surface and hold your breath. Contrary to belief, you are not a fish; you need your lungs. An arterial gas embolism is not a pretty friend. Be sure to stick to your dive tables to plan a safe dive. If you develop tingles, dizziness or other symptoms, remain calm and call the hotline to have them checked.

Don’t mess too much with your ears: Equalise early and often to protect your delicate tympanic membranes (eardrums). You’ll need these organs well into your geriatric years – how else will you hear your great-grandchildren? Don’t forget to equalise your mask – no need to look like a red-eyed Dracula!

Be careful whose advice you buy: Take a refresher course if you are out of practise, revise skills and boost your confidence. Be current with your CPR and first aid skills and make sure you’re able to offer assistance to a fellow diver or buddy in need, whether it’s neuro assessments, hazardous marine life injury treatments or oxygen administration. Remember to supply oxygen first when DCI is suspected.

Don’t rely on luck: Protect yourself against malaria, as well as other bites, stings and tricky encounters with venomous creatures under and above the water. Water: Make sure you are well hydrated. Remember, alcohol and diving don’t mix.

But whatever you do – trust us on the sunscreen…

Question: Lately I feel like I'm getting sunburned much more easily than I used to. I am taking a new medication; is there any chance that could be the cause?

Answer: Sunshine is a welcome addition to just about any day spent outdoors. For many people, a hat, a T-shirt and some sunscreen are sufficient to limit the negative effects of sun exposure.

Certain medications, however, can make people more sensitive to the sun's ultraviolet (UV) rays; this is called photosensitivity. Both regularly and temporarily used medications can cause photosensitivity. Minor symptoms include skin reddening, itching or rash; more serious symptoms include a burn, blisters and discoloration or darkening of the skin. Report any significant or unusual reaction to a medication combined with sun exposure to your prescribing or primary care physician. Some reactions are serious.

There are more than 100 medications, both prescription and over-the-counter, that can cause increased susceptibility to UV rays, and these include both oral and topical medications. The best policy is to first read the label of any medication you take and then ask your physician and/or pharmacist about photosensitivity before exposure to the sun (or a tanning bed).

Drugs that may cause photosensitivity include antibiotics, antihistamines, cardiovascular medications (such as diuretics and blood pressure medications), nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin), some antidepressants and some antipsychotic medications.

Taking a medication that can cause photosensitivity doesn't mean you have to avoid outdoor activities, it just means you should take extra precautions to lessen your exposure to UV light. Consider wearing a wide-brimmed hat, long sleeves and long pants, and reapply your sunscreen more frequently. Stay indoors around mid-day if possible, and seek shade when you're outside.

Do you have a question for the DAN medical team? Use the form below to submit your question.

THE STORY OF A RASH AFTER A DIVE BY DR GARY MORRIS

Skin problems in diving can have various causes, including decompression illness. In this article, we look at the different forms of skin bends and what to do when you think you might be affected.

WHAT HAPPENED?

The diving and visibility had been good and the filming of marine ecosystems was progressing well, but deadlines had to be met, so every opportunity to get shots had to be taken. For the last 10 days, diving had taken place with two or three dives daily, each lasting 45 to 60 minutes. Diving depths were up to 20 m with a lot of variation in depth – going up to get a better view and then down again to assist in another aspect of the work. This required a lot of physical work. The divers were experienced, having done “thousands” of dives in many locations around the world. The area where they were diving, on the coast of South Africa, was very familiar and they knew the conditions. Some of the divers on the team had been ill and could not dive, so the other team members were working harder to get things done. They were fit and healthy, but starting to tire after this intense period of work.

The first dive of this particular day was to a maximum of 18 m and lasted about an hour. The day was beautifully calm and warm. The divers surfaced and one of the most experienced in the group felt pain in her right shoulder on removing her wetsuit. She developed itching, swelling, mottling and a purple-red discolouration of the skin on her upper arm. Other than that, she felt well and had no tingling in her hands and feet, no weakness, no headache or confusion, and she did not feel breathless. She was given oxygen for about 30 minutes and one hour after surfacing, the symptoms had markedly decreased.

THE DIAGNOSIS

The diver and her companions suspected decompression illness (DCI) and contacted the DAN hotline. They were advised to see a local diving doctor to treat possible skin bends. They reached the doctor’s rooms about two hours after surfacing. By that time the symptoms had almost gone, although mild pain persisted in her upper arm.

There was still slight swelling, mottling and redness of her upper arm. Her shoulder was mildly tender, but had its full range of movements. No neurological, chest, heart or other abnormalities were found. A diagnosis of Type 1, pain only, DCI with skin involvement was made. As the symptoms had mostly resolved and there were no signs of neurological involvement (Type 2 DCI), she was treated with a further hour of surface oxygen and given aspirin for the pain. She went home to rest with the instructions to ensure adequate fluid intake and to contact the doctor if any other symptoms developed. She was not permitted to dive for the next seven days. The mild pain and rash persisted for a few days, after which she returned to active diving free of symptoms.  

WHAT ARE "SKIN BENDS" (Cutaneous Decompression Sickness)?

Skin problems in diving can have various causes, including DCI, but rashes and itchiness can also be caused by stings from jellyfish, bluebottles, coral and the spines of sea urchins and various fishes. Suit squeeze or an allergic reaction to the neoprene in wetsuits will cause a rash, pain or itchiness in a pattern resembling the folds and seams of the suit.

DCI with skin manifestations can vary from mild swelling and itching confined to a small area to more widespread and dangerous rashes and mottling that could signal a more serious underlying problem.

Itchiness with no rash

There are many causes for itchy skin after diving. However, where this occurs after chamber or dry suit diving, it may be due to a highly localised form of decompression sickness (DCS). This type is not associated with other systemic manifestations. It is probably due to gas passing into the skin from the high pressure gas surrounding it.

The cause of the itch is thought to be the formation of small bubbles in the epidermis with the release of pressure. The symptoms are mild, temporary itching. No signs can be seen on the skin. The areas most affected are the forearms, wrists, hands, nose and ears. No treatment is needed.

Scarlatiniform rash

This presents as a flat, itchy rash, mainly over the chest, back, shoulders or thighs. The rash appears similar to sunburn. It is also caused by bubble formation in the skin, with the release of histamine and other chemicals. The rash is not associated with any other manifestations of DCI, apart from pain. It clears with oxygen treatment or spontaneously in a few hours. Recompression is usually not needed unless the rash progresses to the more serious form or neurological symptoms develop.

Marbling of skin (cutis marmorata)

This is a serious form of skin bends and looks mottled, with various shades of bright red, purplish or even bluish skin, with an uneven, marble-like pattern. Swelling occurs and the skin takes on an “orange-peel” appearance. The skin can be very itchy and irritated at first. It is also most common on the torso, shoulders and thighs. The colouration may appear in patches or in severe cases may begin on the chest and spread downwards. The signs on the skin indicate what is happening elsewhere in the body. Gas bubbles are found in the skin, underlying tissue and blood vessels. This is a serious condition and is usually found in conjunction with neurological DCI. A diver with this condition requires recompression.

WHAT IS THE SIGNIFICANCE OF SKIN BENDS?

Skin bends can indicate underlying or developing serious decompression problems

Cutaneous DCS symptoms have been known to manifest before or along with the symptoms of more serious types of DCS, such as neurological DCS. The sooner a diver gets help, the greater the chances of a full recovery. Recognising a skin bend may be the first step to timeous and effective treatment.

Skin bends may indicate a patent foramen ovale

A patent foramen ovale (PFO) is a heart condition that is thought to increase the risk of serious DCI. There appears to be a correlation between skin bends from dives well within the recreational dive tables and the presence of a PFO. Divers who have a history of undeserved skin bends are advised to seek the opinion of a diving doctor.

WHAT TO DO WHEN YOU THINK YOU HAVE SKIN BENDS

Whatever the cause, either the depth or duration of the dive, skin bends usually appear within a few minutes to a few hours after surfacing. If you notice or develop a problem with your skin after a dive, follow the rule – it is a bend until proven otherwise. When a skin bend is suspected, the following should be done:

• Give oxygen by mask.
• Note the distribution, time of onset and progress of the rash as well as the response to oxygen and the development of other symptoms.
• Contact the DAN hotline to discuss the symptoms and how to proceed.

Every day, divers and emergency-response personnel around the world trust DAN’s oxygen units and first-aid kits to perform in an emergency. That’s because DAN’s products have been developed, tested and refined with input from leading doctors and researchers to meet the discriminating requirements of the diving community. Be ready to respond. Explore DANShop.co.za to make sure you are prepared with the latest safety equipment to effectively handle any dive emergency.

Whether it is being on the scene of an accident or witnessing a health-related emergency, most people will be involved in a crisis situation at some point in their lives. Are you prepared to help? Do you have the skills to respond quickly?

Developed by medical experts, DAN’s courses are easy to understand and designed to provide you with the skills and confidence you need to respond in emergency situations. DAN first aid courses prepare divers to manage injuries related to scuba diving. All courses meet the 2015 ILCOR and AHA CPR guidelines. The training can also extend to other environments. Isn’t it worth a few hours one evening or weekend to learn the skills that could save a life?

Alert Diver is the dive industry’s leading publication. Featuring DAN’s core content of dive safety, research, education and medical information, each issue is a must-read reference, archived and shared by passionate scuba enthusiasts. In addition, Alert Diver showcases fascinating dive destinations and marine environmental topics through images from the world’s greatest underwater photographers and stories from the most experienced and eloquent dive journalists in the business.