Emergency Oxygen

By Jim Gunderson | Photo by Stephen Frink

It was a beautiful, warm Saturday in the Pacific Northwest. We were conducting two checkout dives for an advanced open-water course at a popular dive site in Puget Sound. I had just gotten some divers out of the water. We debriefed onshore as divers from an introductory open-water class exited the water with their instructor. One of the divers, an older man, looked a bit distressed as he hiked up the slight embankment to the parking lot. He started coughing as he came up the hill. I noticed but initially dismissed it as a regular, minor cough and continued working with my students.  

A couple of minutes later, he and a couple of other students from his class sat down near our class, and I heard the cough again. This time it caught my attention — I could hear there was something entirely wrong.

His instructor was still down by the shore assisting his other students, so I decided to step in. As I approached him, he coughed again, and when he removed his hand from his mouth, I noticed a pink, frothy substance. I performed a quick, primary assessment and immediately called for some oxygen. My divemaster delivered the kit, and we proceeded to administer oxygen using a demand valve as the diver was responsive and breathing.

The instructor came up as we started the oxygen. We advised him of the situation and that we had already called 911. We performed a secondary assessment and continued monitoring the injured diver until the ambulance arrived a few minutes later. As part of the secondary assessment, we conducted a S-A-M-P-L-E survey (signs/symptoms, allergies, medications, pertinent medical history, last oral intake, and events leading to the current situation). The only sign or symptom was a productive cough with pink, frothy sputum. The injured diver reported no known allergies and stated that he took high blood pressure medication. His past medical history revealed some lung issues, but his physician had cleared him to dive before taking the course. His last oral intake was breakfast that morning, and the event leading up to the incident was the activity during the dive.

The dive was a typical open-water checkout dive for the Pacific Northwest: cold water (about 55°F) and 7 mm wetsuits with hoods and gloves for exposure protection. He was diving with a standard recreational gear configuration and breathing air. The dive plan was a maximum of 30 feet for 30 minutes. During the dive, the class worked on various skills, such as mask clears, regulator recovery, and an emergency swimming ascent. The emergency swimming ascent started from about 20 feet, and divers performed the other skills near the bottom. The injured diver reported no issues with the descent or equalization, and he stated that he felt pretty comfortable during the beginning of the dive. As the dive progressed, he became increasingly aware of the cold and the wetsuit constricting, especially at depth.  

The instructor monitored the students throughout the dive, and the injured diver never reported any issues to the instructor underwater. The diver conducted the emergency swimming ascent as instructed and reached the surface. He and the instructor said the ascent was smooth, slow, and controlled. The student was using analogue gauges, so we could not verify his profile. He reported that the coughing had started on the surface. 
When emergency medical services arrived, we provided them with a summary of our assessment findings, what interventions we had done, and any changes we had noticed. EMS continued the oxygen with a high-flow nonrebreather mask and transported him to the nearest hospital. We advised EMS and the injured diver to contact DAN if they had any questions and provided the DAN Emergency Hotline number.

Not being medical doctors, we could only surmise what had happened. We suspected that various factors, including: the cold water; the stress of the dive, and the changes in pressure from the emergency swimming ascent, exacerbated his preexisting lung condition and led to potential lung barotrauma or pulmonary oedema.
 
We followed up with the instructor a few days later to see how his student was doing. He was grateful that we had been there and were willing to assist. While we never received a formal diagnosis, the instructor informed us that his student had been discharged from the hospital and was recovering well. Because of the incident, the student decided to get reassessed for diving before completing his certification.

Thanks to the training we had through DAN’s Emergency Oxygen for Scuba Diving Injuries course, we could adequately address the situation for a favourable outcome.