DEMP: For more than dive Emergencies

By Michael Wilhelm

When I finished DAN’s Diving Emergency Management Provider (DEMP) course at my local dive shop in Washington, D.C., on a Sunday evening, I thought that I might use the skills I learned on a future dive trip, if at all. They became unexpectedly necessary five days later when a neighbour called to tell me that something was wrong with her elderly housekeeper and asked if I would check on her.

When I arrived at my neighbour’s condo unit, the housekeeper was seated in a chair compulsively looking through her purse but was unable to articulate what she was looking for. I was unsure whether she was suffering from dementia or had sustained an injury. I recalled from the DEMP course that some simple tests could determine if I needed to call for emergency help. We had also learned about orientation questions used to determine a person’s cognitive status — whether a person was oriented to time, place, person and situation. The housekeeper was able to answer some of the basic questions. She was able to tell me her name, and she knew that she was in the condominium unit and that it was morning. But she could not tell me why she was there, why she was seated in the chair or what she was looking for in her repeated searches of her purse.

She denied she was diabetic but confirmed that she took some medications, although she couldn’t tell me what they were or for what conditions they treated. She allowed me to look in her purse, and I found a prescription drug that I recognised as a diuretic, which suggested to me that she likely suffered from hypertension. I asked her if the medicine was what she was looking for in her purse, but she said it wasn’t.

At that point, I was uncertain if I should call 911 and ask for emergency medical services (EMS) to be dispatched. I recalled learning about stroke symptoms and decided to apply some of the tests we had practised during the skills portion of the course.

I first asked her to close her eyes and give me a big smile. She did so, and I noticed no droop in her facial expression. I asked her to squeeze my fingers with both her hands and found no difference in the pressure she applied to each hand. She was able to hold her head steady and to follow my extended finger with her eyes. I noticed no jerky movement called nystagmus as I moved my finger left, right, up and down.

I retrieved a blood pressure kit and a pulse oximeter from my condo unit and measured her blood pressure at 240/115 with a pulse of 114 and an oxygen saturation of 91 percent. That was evidence to suspect that something had happened to her that required more assistance than I could provide. I thought it might be the aftereffects of a transient ischemic attack (TIA), which we had discussed in the DEMP training.

After consulting with my neighbour and explaining to the housekeeper what I was advising, I called 911 and reported that we were concerned about a female in her 80's with cognitive impairment, excessively high blood pressure and low blood oxygen saturation. The operator said that she would dispatch an EMS team, which arrived within minutes. The paramedics performed the same neurological tests that I had, observed the same high blood pressure and low oxygen saturation and decided to transport her to a local hospital. They also believed that a TIA had left the patient with a cognitive deficit. She remained in the hospital for more than two days until she was stabilised.

Although it was not an in-water lifesaving event, it was significant to me because it occurred so soon after my DEMP training. In retrospect, I should have retrieved the DAN flash cards given out at the training instead of relying on memory for the examination. If I hadn’t taken the DEMP training, however, I would have been at a loss for what to do. I felt confident that the training had equipped me to rule out a stroke and to recognise that what I was observing was not merely age-related cognitive impairment but evidence of a recent physical event. I was also gratified that I was able to reassure my neighbour, who was very concerned about the well-being of her longtime housekeeper.

DEMP training, which teaches all the skills from four different first aid courses, can prove useful for more than just dive-related incidents. A spouse, friend or neighbor may need immediate CPR, and you may be the only one available to provide it. A person’s survival in an automobile accident could depend on your training to control bleeding. A training exercise in how to perform the Heimlich maneuver may give you the skills to prevent asphyxiation in a restaurant someday. It’s a worthwhile course that goes beyond helping divers in distress and gives you the knowledge to confidently respond to many different kinds of emergencies. AD

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