DAN AP Alert Diver Magazine Q3, 2016

The Magazine of Divers Alert Network Asia-Pacific

KIDS AND DIVING IPE CHANGED MY LIFE WEIRDLY WARMING WATER CARE FOR YOUR GEAR Quarter 3, 2016 danap.org

Contents

ON THE COVER A delicate ribbon eel peers out of the reef at Tavenui Island in Fiji Image ©️ Stephen Frink Settings: f/20, 1/125s, ISO 160

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53 Perspectives

KNOWING WHEN TO CALL A DIVE Text by Scott Jamieson

54 DAN Was There For Me

THE CAVERN DIVE THAT CHANGED MY LIFE Text by DAN AP Member Allen Nash

60 Incident Insight TOO SOON TO FLY?

Text by DAN AP’s John Lippmann and Scott Jamieson

62 Expert Opinions CHILDREN AND DIVING Text by Matías Nochetto, M.D.

Founder, Director of Research & Chairman of the Board John Lippmann General Manager Scott Jamieson Administration Manager Sim Huber

Text by Allison Vitsky Sallmon

Marketing & Communications Manager Melissa Cefai

73 Gear

STORE IT SMART

54 ALERT DIVER’S PHILOSOPHY

Alert Diver is a forum for ideas and information relative to diving safety, education and practice.

Any material relating to dive safety or dive medicine or accident management is considered for publication. Ideas, comments and support are encouraged and appreciated. The views expressed by contributors are not necessarily those advocated by DAN Asia-Pacific. DAN is a neutral public service organisation which attempts to interact with all diving-related organisations or persons with equal deference. Alert Diver is published for the use of the diving public and it is not a medical journal. The use and dosage of any medication by a diver should be under the supervision of his or her physician.

Editors Brian Harper and Diana Palmer

68 Water Planet

A PERFECT STORM OF WARM

Content Coordinator Stephen Frink

Alert Diver is published as a separate, independent magazine within Scuba Diver AUSTRALASIA (SDAA) magazine. DAN AsiaPacific is not responsible for the content provided elsewhere within SDAA, and therefore this content should not be assumed to represent the views, policies or practices of DAN Asia-Pacific or Alert Diver magazine. ©Alert Diver text, illustration or photographs may not be reproduced or reprinted without the expressed consent of Divers Alert Network and its authors, artists and photographers. Many articles are reprinted with the kind permission of DAN America.

Email: info@danap.org For more information on membership, insurances and training programmes, visit our website: www.danap.org

DAN AP Board of Directors John Lippmann, David Natoli, Malcolm Hill, Dr David Wilkinson, Mick Jackson, Stan Bugg, Nicholas Cheong and Dr Andrew Ng Memberships & Certifications Heidi Powell, Julie Parsonson, Cynthia Van Zyl, Mina Chiovitti, Sophie Kayne, and Diane Boyle Training John Lippmann, David Natoli and Tim Vernon-Smith Marketing Assistants Haili Mu & Adam Lippmann Accounts Anny Limbek

DAN AP does not necessarily endorse the products or services of any organisation or company whose advisements appear in Alert Diver

Perspectives

From DAN Asia-Pacific

KNOWING WHEN TO CALL A DIVE

Part of the DAN Asia Pacific team.

From left, Mel, Cynthia, Julie, John, Heidi, Scott, Haili, Anny, Adam, Sim

DURING OUR BASIC dive training we are taught that if a dive doesn’t feel right we should abort it. The reality is, despite these lessons, many people find themselves on dives for which they lack the confidence or experience to be undertaking. This places unnecessary stress on the diver, both physically and mentally, and this can lead to unnecessary incidents involving injury or even death.

Every diver should know their limits – should know what dives they should be doing and the ones they should avoid. However, this knowledge is only half the equation; the remainder is the confidence to say no to a dive, even if you have arrived at the site, have suited up, or even after you’ve started the dive.

No diver should ever feel pressure to complete a dive they are uncomfortable with, and this is something buddies should discuss. It should be clear that there is no issue with aborting a dive, and it should be understood, by both buddies, that if either one feels uncomfortable they both end the dive immediately.

At DAN AP we see all kinds of diving accidents and injuries. Unfortunately, a number of these are the result of divers participating in dives they were uncomfortable with from the outset. We hear of divers expressing doubts about some aspect of the dive, going ahead with the dive anyway, and then having an issue during the dive, which led to an injury, or worse.

In order for divers to make an informed decision as to whether or not to complete a dive, it is important for divers to know, from the outset: • their personal limits (type of dives they are comfortable doing, level of training, etc.); • the type of dive to be undertaken; • the conditions expected and possible hazards.

Being able to make such decisions is an important part of every diver’s pre-dive checklist, as important as checking your cylinder contents or putting on your mask.

If you don’t feel confident about doing a dive, tell the dive leader or tell your buddy: “I think I will sit this one out.” It’s much better to make this call early than to become a statistic in DAN AP’s incident reports.

Dive safely, Scott Jamieson, DAN AP General Manager

Dive Tip Engage with DAN on Facebook for insights into various dive safety and medical issues.

Scan here or search DAN Asia Pacific.

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Research, Education & Medicine

DAN Was There For Me

THE CAVERN DIVE THAT CHANGED MY LIFE A serious case results in one DAN AP Member, a dive industry veteran of more than 30 years and a PADI Course Director, having to make the life-altering decision to stop diving Text by Allan Nash Images by Becky Schott

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MY INCIDENT I was undertaking a long cavern dive with my new and never-been-dived-before rebreather with newly designed and neverbefore-used back counter lungs. During the dive I experienced cramps, so cut short what was going to be a two-kilometre expedition.

Assuming I was dehydrated, I took a double dose of a rehydration product (thinking I was doing the right thing), which stopped the cramps.

I was on my fourth day and fourth dive.

The plan was to complete a three-hour dive in the cavern system with the rebreather. I did all the usual pre-dive checks, including a

the past three dives, resolved a few small issues I was having.

At 55 minutes into the dive I seriously questioned if I could suffer three hours of this.

After 60 minutes I started to inhale not only through my mouth but also uncontrollably through my nose. At 75 minutes I was so frustrated I had to do something; and that was to bail out of the dive. I bailed out to OC and almost immediately recovered normal breathing and felt better. I stayed on OC for a few minutes, and then knowing I was close to the exit, I switched back to CCR, and felt completely okay. We ascended and I was prepared to discuss with my buddy what had happened, with the intention of continuing the dive.

It wasn’t until I broke surface that I could feel and hear a gurgling sound with every breath.

Getting out of the water was difficult, breathing was difficult, I was tired, and struggled to walk

I could feel and hear a gurgling sound with every breath. Getting out of the water was difficult, breathing was difficult, I was tired and struggled to walk

pre-dive pre-breathing with the unit before descent. My buddy and I descended, checked our cells were working, and then switched to CCR. It took a few moments to orientate and get somewhat comfortable; but I never got completely comfortable and felt like I was struggling with the unit the whole dive.

Something just didn’t feel right, and I put it down to: 1. a new CCR; 2. I had little time with a CCR since being certified two months before; 3. I had to spend time and work through each problem until I was comfortable. I had, over 55

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up the stairs back to the car, needing to stop many times to get my breath and the strength to carry on. The breathing difficulty continued with the gurgling for the best part of 15 minutes before subsiding; then I just felt tired and out of breath.

My buddy put his finger right on what it was and we called DAN to confirm. DAN advised that what I described certainly sounded much like Immersion Pulmonary Oedema (IPE), which is a much misunderstood area and a lot of what is known is speculation based on theories and studies of cases under very different conditions.

I visited a doctor after the incident in Cozumel and underwent some testing. The doctor confirmed that my “over-hydration” may have been part of why I experienced IPE. In one Alert Diver article that I read on IPE, it suggested that one of the causes leading to IPE is excess hydration coupled with rapid onset of heavy swimming exercise.

I really connected with this explanation. Of course it could have been many things, but after talking with the doctor, reading the DAN article, and thinking back on the days before and during the dive, I believe the contributing factors to my IPE incident were: • not feeling comfortable; • struggling with the CCR would have increased my breathing difficulty (even though I would have denied that happening during the dive); • my over-hydration; and • I also suffer from a heart condition, which could have been a potential contributor.

The rate of recurrence is not confirmed but, on current information, appears to be around 30 percent, which is reasonably high. The decision as to whether a diver who has had an episode of IPE should continue diving is a difficult one and largely based on the level of risk the diver (or sometimes their employer) is willing to take. It may be partly based on the physical condition of the diver, a history of hypertension or cardiovascular disease and the type of diving being considered. Shallow, warm-water diving in a young, otherwise healthy diver who suffered a mild case of IPE is less concerning than an older diver with multiple medical problems who wants to return to cold-water diving after a severe episode. Another factor to consider is the access to very prompt oxygen first aid and medical care should an incident occur. Prompt and appropriate oxygen first aid can be life-saving in a severe case of IPE. Allan was told that he would be unlucky to have another episode but it is certainly possible and that these can sometimes be fatal. He was advised to think carefully about the level of risk he was prepared to take. He was also advised that, should he continue to dive, he should avoid going deep, avoid cold water and currents, ensure he could ascend directly to the surface, and to make sure that oxygen was readily available.

Reading Allan’s comments below raises some concern as snorkelling in cold water with a restrictive wetsuit could be a potential trigger.

One of the causes leading to IPE is excess hydration coupled with rapid onset of heavy swimming exercise

The burning question for me after this incident was: Am I likely to experience IPE again if I continue to dive?

INSIGHTS FROM DAN ASIA-PACIFIC’S JOHN LIPPMANN Relatively little is known about IPE but it is an area of increased interest. Early reports were mainly about IPE in military combat swimmers and in triathletes. However, there are a growing number of reports about recreational snorkellers and divers who have suffered the condition. IPE is implicated in some fatalities although, unless the incident was witnessed, at autopsy it’s usually hard to tell the difference between IPE and drowning.

The most common demographic for IPE during scuba diving (known as scuba diver’s pulmonary edema – SDPE) is middle-aged women. Predisposing factors for SDPE appear to include immersion, age, gender, aspiration of seawater, over-hydration, cold exposure, stress, negative inspiratory pressure, asthma, hypertension, diabetes, drugs (e.g., betablockers), technical diving, and cardiac disease or disorder.

Allan Nash, who has now decided to restrict his diving activities to snorkelling

Research, Education & Medicine

My IPE has had a big impact on my life. I decided to really restrict my diving as I didn’t want to tempt fate

FINAL COMMENTS FROM ALLAN My IPE has had a big impact on my life. I decided to really restrict my diving as I didn’t want to tempt fate, knowing that IPE could happen to me again and it could take my life. But to get around it, and to stay in the sea, I have taken up snorkelling and I have done a trip to Norway to snorkel with orca and humpback whales. This trip got me inspired about being in the ocean again and I will be heading to Antarctica next year to snorkel with leopard seals. I know that snorkelling in cold water has a risk and that using a drysuit with a tight neck could contribute to an onset of IPE, but it is about managing risk, and part of this will be ensuring that I am always close to a boat or an exit, so I can act fast if I feel an IPE recurrence.

What is IPE? Pulmonary edema is an abnormal leakage of fluid from the bloodstream into the alveoli, the microscopic air sacs in the lungs. IPE presents as a rapid onset of shortness of breath, cough and sometimes blood-tinged, frothy sputum.

Because the fluid builds up in the air-containing spaces of the lungs and interrupts gas exchange, IPE resembles drowning. The important difference is that the obstructing fluid comes from within the body rather than from inhalation of surrounding water. Like in Allan’s case, after an episode of IPE, there is often spontaneous recovery once the diver leaves the water.

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Research, Education & Medicine

INCIDENT INSIGHT

TOO SOON TO FLY? Waiting to take a plane home could have prevented the need for further treatment for this DAN Member

THE DIVER’S EXPERIENCE

By DAN Asia Pacific

550+ dives over a 30-year period

THE DIVER An Australian living in India

THE TRIP

A 6-day diving holiday in the Maldives

THE DIVES • Five dives completed within 36-hours • All divers were between 22 and 31 metres • All dives were on air and approximately 60 minutes in duration • On all dives the computer was set to default settings with no added conservatism, despite multiple days of planned diving at depths between 20 and 30 metres

DIVE PROFILES Day 1 DIVE 1 30.6m, 55mins

Surface Interval (SI)

1hr 56mins

Surface Interval (SI)

DIVE 2 30.6m, 56mins

5h 18mins

Surface Interval (SI)

Day 2 DIVE 3 22m, 64mins

After a surface interval of just under 13 hours

DIVE 1 31.3m, 60mins

1h 58mins

DIVE 2 31.2m, 65mins

ONSET OF SYMPTOMS 1. Several minutes after surfacing from the second dive on Day 2, the diver experienced numbness and tingling on the right side of her body, including her arm, side and leg.

2. The numbness and tingling extended to the left leg and under the right breast.

3. The boat crew commenced oxygen first aid quickly. The symptoms partially resolved after 25–30 minutes, and fully resolved in her left leg after 60 minutes of breathing oxygen.

4. The boat crew contacted the hyperbaric chamber on an island near Malé and she was transferred there for evaluation and, if needed, further treatment.

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DIAGNOSIS Decompression illness (DCI) with peripheral neurological symptoms

©123rf

TREATMENT The diver underwent two recompression treatments: • March 25 at 1530: Comex18 Treatment • March 26 at 0730: HBO US Navy Treatment Table 5

RECOVERY Thirty minutes into the first treatment the diver’s symptoms resolved, except for the abnormal skin sensation of “insects crawling” on her right leg and under the right breast.

After the second treatment, the chamber declared the diver fit to fly back to Mumbai after only 24 hours despite having some residual symptoms. The diver was informed about possible therapy required for symptoms presenting during the flight.

DAN AP on-call staff and the on-call DES doctor both expressed concern at this short period and suggested that the diver wait a minimum of 72 hours between

treatment and flying. In fact, given that she had residual symptoms, the time should have been significantly extended. The diver would have likely benefited from additional treatment.

Despite DAN’s advice, the diver was determined to fly, and flew home less than 24 hours after her second treatment.

Fortunately, the diver’s symptoms did not substantially worsen on the flight, or subsequently; however, she still had a small numb patch on her leg and some residual tingling in the right leg that required additional treatments in Mumbai.

INITIAL COSTS • Chamber Treatment 1: US$4,500 • Chamber Treatment 2: US$2,500 • Doctor’s Fee: US$570 TOTAL (inclusive of GST): US$8,474.40.

After returning to Mumbai, the diver received four further chamber treatments and various other medical services. As a DAN AP Member with dive injury insurance, the costs relating to the treatment of her DCI and transportation were covered by DAN.

ANALYSIS

This diver probably worsened the outcome by flying home so soon after her initial treatments, especially with unresolved symptoms. There was also a delay of four days between the treatment in the Maldives and subsequent treatments in India.

Delays in treatment, and flying prematurely, can both result in a worsening of symptoms and/or decrease the benefits of subsequent treatments. Had she remained longer in the Maldives (with or without further care) she may not have required further treatment on returning home.

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Research, Education & Medicine

Expert Opinions

CHILDREN AND DIVING What are the real concerns?

By MatĂ­as Nochetto, M.D.

When recreational diving equipment became commercially available in the 1950s, scuba was established as an exciting activity for courageous adepts all over the world. As equipment and confidence in technique evolved, diving became available to more people, including children.

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Children and diving, however, is not without controversy. Concerns range from kids not having sufficient body size and strength to aid a fellow diver to the risk of inhibited bone growth and other medical concerns.

Children are not small adults. They are still growing, with different organs and systems developing at various speeds. They are maturing and evolving both physically and psychologically.

Children are predisposed to ear infections as a consequence of their Eustachian tubes’ immature form and function, which may also increase their risk of middle-ear barotrauma.

Perhaps the most significant concern about children and diving involves psychology and cognitive ability. Children often lack the mental maturity to understand and manage invisible risks, and they can behave unpredictably in stressful circumstances. Adherence to plans can be a problem for those who are easily distracted.

Diving and dive training practices currently address the physical, physiological and psychological challenges inherent to children by adapting equipment, modifying techniques, limiting exposure and mandating strict supervision.

Data about diving injuries among children are very scarce. Limited statistics available through some training agencies do not provide any cause for alarm, and injuries reported through the DAN Emergency Hotline rarely involve children. Some dive instructors praise youngsters’ surprisingly good water skills; others argue that a single diverelated fatality in a child would be too many.

We ask the experts.

Perhaps the most significant concern involves psychology and cognitive ability.

Children often lack the mental maturity to understand and manage invisible risks

©Wayne Hasson

WHAT RISKS CONCERN YOU MOST WHEN IT COMES TO YOUNG DIVERS? Simon Mitchell: I am generally relaxed about diving by children provided there is strict adherence to the recommendations around training, supervision and scope of diving promulgated by the major training organisations.

I think the biggest potential problems relate to emotional and behavioural immaturity in children that may lead them to make poor decisions or be inattentive to plans. This concern can be mitigated by appropriate supervision.

Children burn lots of calories, and the resulting heat provides them with good tolerance to cold. Once the expendable calories are exhausted, however, without adequate thermal insulation children may be more prone to hypothermia, and their relatively high bodymass-to-surface-area ratio leads to accelerated heat loss.

Childhood asthma underscores how pulmonary function is still evolving in young people, and any risk of air trapping is a serious concern when breathing compressed gas.

David Charash: In general the risks of diving include barotrauma, decompression sickness, arterial gas embolism, panic, drowning and traumatic events. The risks of diving don’t discriminate based on age or experience. So the real questions are: • How well can an individual diver handle a given problem?

• Can the diver understand the level of risk present and decide on the degree of risk he or she is willing to accept?

• Can a child mitigate the risk by adjusting his or her dive profile?

Thomas March: By and large the paediatric population is quite healthy. We worry much more about mental errors that are unforgiving in scuba. The frontal lobe, which is associated with judgement, is generally not fully developed until the mid-20s. Panic, overconfidence and anxiety are serious concerns in the paediatric population.

I also worry that many paediatric-age divers do not have the physical strength and/or skills to be a dive buddy responsible for the life of another diver.

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Research, Education & Medicine

A child should always be paired with an adult who has the experience to deal with the child’s short attention span and tendency to be distracted

David Wakely: Inexperienced adult divers are the greatest risk to children who dive. A child diver has a very different mindset from that of an experienced adult. Adults who think the child they are diving with is capable of all conditions and scenarios, who jump in the water beside the child but do not really watch them closely, are dangerous buddies for a child to have.

A child should always be paired with an adult who has the experience to deal with the child’s short attention span and tendency to be distracted by shiny objects. The adult should constantly monitor the child’s air and depth, swimming position and rate of ascent or descent.

DO YOU THINK THAT LIMITING THE EXPOSURE MAKES DIVING SAFER FOR CHILDREN? Mitchell: Limiting depth/time exposures makes diving safer for adults and children. It is one of a number of pragmatic ways of mitigating the possibility that children may be more prone to events such as running out of air and rapid ascent. It clearly does not affect the risk of some diving problems such as barotraumas.

Charash: Intuitively, placing a clear and defined limit on depth and time of exposure is likely to add an additional layer of safety in children, but we must not forget that there is risk at any depth and dive time.

March: Turning loose young divers with compressed air even in shallow depths may be a big mistake. In my opinion it’s more important that the instructor has the skills to assess a young diver’s ability to be mentored.

Stratification based on skills and experience – as seen in martial arts training, for example – could be useful. Many young divers are eventually able to appreciate the risks, but readiness can vary dramatically and depends much less on age than maturity. I think efforts to credential specialised instructors might be worthwhile.

Wakely: A graduated response to learning and freedom to dive is essential for child safety. I like to use the analogy of skiing – it’s a potentially dangerous sport, but there are few adults who argue that children shouldn’t be skiing. It’s widely accepted that children should start on gentle slopes, wear a helmet and gradually move up to more advanced terrain according to their abilities.

IS DECOMPRESSION STRESS A CONCERN WITH REGARD TO LONG BONE DEVELOPMENT IN CHILDREN? Mitchell: There is no evidence for it. The epiphyseal plates of the long bones do not close until late adolescence, and there has been extensive diving by teenagers for decades.

Despite this, I am unaware of a single case of

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apparent growth inhibition in a limb as a result of decompression sickness in a teenager.

Charash: There are no studies that show clear evidence that diving (decompression stress) can affect long bone development in young divers.

What is not so clear is the effect of microbubbles that may enter the circulation and possibly affect the blood vessels in the growth plates (epiphyseal plates). I suggest limiting children’s exposure to nitrogen by restricting depth and dive time and increasing surface interval time.

March: We know that tissue perfusion in the growth plates is significantly different from that in most other body compartments. This is clear because we find paediatric patients much more susceptible to bloodstream infections in these areas. The standard gas-compartment models

©Stephen Frink

are likely inadequate as routine dive tables, and experimental confirmation is neither ethical nor practical. The general consensus of a margin of safety seems prudent.

Wakely: There is no evidence that the hyperbaric environment has any ill effect on growing bones. The Undersea and Hyperbaric Medical Society (UHMS) lists 14 medical conditions that are known to benefit from hyperbaric oxygen therapy (HBOT). For two of these conditions, osteomyelitis (long-term bone infection) and osteoradionecrosis (bone damaged by radiation therapy), the HBOT addresses the underlying problem (infection and dead bone), encourages new blood vessels to form in the bone and allows the bone to heal itself. HBOT has no known negative effect on healthy bone of any age.

DO YOU THINK 10-YEAR-OLDS HAVE THE MENTAL MATURITY TO UNDERSTAND AND MANAGE THE INVISIBLE RISKS INVOLVED IN SCUBA DIVING? Mitchell: The question requires context. Within the framework of a dive training programme and guidelines of practice designed specifically for this age group, my answer would be “yes, in most cases”. Put another way, if the supervision and depth/time recommendations for diving are adhered to, then most properly motivated 10-year-olds should be fine. But if the question is whether a 10-year-old should be considered an independent open-water diver (as we understand that concept in adults), then my answer would be no.

Charash: To answer this question it is important to understand normal childhood growth and

Research, Education & Medicine

development. As there is significant variation in maturity and development, it is not possible to predict who will have the capacity to understand and also manage risk. Specific to the question, it would be a challenge to expect a 10-year-old to understand “invisible risk”.

March: Many 10-year-olds may be capable, but many more may not be. Unfortunately there are often incentives for instructors, parents and even dive operations to train unready students. Adults who have the skills to assess the readiness of paediatric-age divers can facilitate positive and acceptably safe in-water experiences for kids of any skill level.

Prioritising positive experiences for paediatric-age students allows for better advancement of all skill levels and avoids the all-or-none dichotomy of certification-focused programmes. This also prevents a sense of failure for students unable to complete certification and may relieve some of the pressure parents place on instructors to certify students.

Wakely: Every child is different, but between the ages of 7 and 11 children’s cognitive abilities change in two ways. First, concrete thinking occurs. This is the ability to solve logical

problems that apply to actual objects or events.

Second, children become less egocentric and develop the ability to view things from others’ perspectives. So the average 10-year-old should have the mental maturity to understand the concept of risk and be able to solve concrete gear-related problems. However, the formal operational stage of thinking – using abstract thought and applying it to problems that have not even occurred yet – does not manifest in most children until ages 11 to 15. The major dive training agencies’ programmes for young divers do a good job of reflecting these stages of cognitive development.

WHAT CHARACTERISTICS DO YOU CONSIDER NECESSARY FOR A CHILD TO BE A GOOD CANDIDATE FOR SCUBA DIVING? Mitchell: The most important thing is that the child wants to dive. It is also vitally important that the parents are supportive and wholly involved in the decision to allow diving, acting as informed risk-acceptors on the child’s behalf.

The child should exhibit a level of emotional, intellectual and physical maturity compatible with the scope of diving prescribed for his age group. Note that these characteristics cannot be adequately assessed in an officebased consultation. Thus, the evaluation of a child’s suitability for diving is substantially the responsibility of the diving instructor who sees the child perform in the water, rather than the doctor.

©Stephen Frink

Charash: There are five components that suggest that a given child is a good candidate for scuba: medical fitness (absence of any medical condition that could affect safety), psychological fitness (appropriate motivation for diving and achievement of relevant developmental milestones), physical fitness (capability to manage equipment and swim against a current), knowledge (knowing how to respond to situations appropriately) and skills (ability to clear a mask, buddy breathe, etc.).

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March: Demonstrated surface skills such as breathing through a snorkel without anxiety are minimal requirements for undertaking instruction. Poor attention span, overconfidence and anxiety would seem to be exclusionary criteria. Paediatric patients do well with incrementally increasing responsibility.

Unfortunately age alone is not a good indicator of developmental capabilities, and tailoring advancement based on the individual’s readiness requires skills on the part of the instructor and mentors. As we consider the potential risks and harm that can be done, we must also balance this with the opportunities for enriching the appreciation of the underwater world and developing confidence and skills in our future generations of divers.

MEET THE EXPERTS

©Wayne Hasson

David Charash, D.O., CWS, FACEP, UHM, is medical director of wound care and hyperbaric medicine at Danbury Hospital in Connecticut. He is a certified diving medical examiner as well as a DAN Referral Physician and DAN Instructor.

Dr. Charash lectures locally and nationally on dive safety and dive medicine.

Wakely: Several factors should be considered when assessing a child scuba student.

Psychological maturity: Candidates should be calm and rational, not prone to extreme emotional outbursts and not prone to anxiety in unfamiliar situations. They need to understand risk and risk avoidance.

Medically fit: Asthma, ADHD and morbid obesity are prevalent today, and these three conditions commonly disqualify children from diving. If you are considering arranging for your child to learn to dive, discuss your plans with a doctor familiar with dive medicine.

they worry their child will be prevented from diving. Full disclosure of all medical conditions is crucial – not only to maximise the child’s safety but also so the dive operator can accommodate any special needs the child may have.

For example, we once had a child with autism in our programme and were unaware of his condition until he panicked during his first open-water dive. He became very agitated and aggressive. Thankfully no one was hurt, but the child had to be removed from the programme, which was humiliating for him. Had we known about his autism we would have provided him with his own private instructor who had experience teaching children with autism.

Parents should be aware, however, that not all dive operators have experience working with children. Adequate oversight should not be taken for granted. I recommend that parents ask dive operators the following questions before their children go diving: • Is a first aid kit and oxygen unit on board or nearby?

• Is a radio or cell phone available?

• Are all staff divers current and active divemasters or instructors? (Don’t hesitate to ask to see their C-cards.)

• What are the depths and conditions of the dives? (Make sure the child won’t be diving deeper than what is recommended for his or her age.)

• Do any of the instructors have training or experience working with kids?

• Does the boat have a safety tank, dropline and dive flag on board?

WHAT HAS BEEN YOUR BIGGEST CHALLENGE IN TRAINING YOUNG DIVERS? Margo Peyton: My biggest job is educating parents. Parents frequently fail to disclose important information on medical forms because

Parents should request a refresher course for children who have not been diving in 12 months, and they should not hesitate to ask that a divemaster accompany them if they aren’t comfortable diving alone with their child.

Educational maturity: The child should be able to learn independently. Learning scuba theory is a big undertaking, and the students must be able to concentrate on the material and know when to ask questions. They should be able to understand what they are reading enough to apply the principles described to situations they see around them in daily life.

Physical maturity: The child should be able to swim and should be very comfortable in and around water. Currently dive equipment for very small children is hard to find, so the child should be physically large enough to wear the available gear correctly and safely.

Desire to dive: The desire to dive must come from the child, not the parent. A dad asking an instructor to teach his son is very different from a child who wants to learn to dive like his dad.

Thomas March, M.D., a practising paediatrician for 30 years, has a special interest in developmentally and behaviourally challenged paediatric patients. A diver for more than 35 years, he has special training and interest in administrative medicine and fitnessto-dive evaluations.

Simon Mitchell, MB, ChB, Ph.D., FUHM, FANZCA, is a physician who is widely published in his specialist fields of anaesthesiology and dive medicine. Head of the department of anaesthesiology at the University of Auckland, he is an avid technical diver, a Fellow of the Explorers Club and the 2015 DAN/Rolex Diver of the Year.

Margo Peyton, MSDT, is a scuba educator, member of the Women Divers Hall of Fame and the founder and director of Kids Sea Camp, through which more than 5,900 young people have learned to dive. Each year roughly 1,2001,600 students dive with Kids Sea Camp, which has a perfect safety record.

David Wakely, FRCEM, FRCS, MBBS, BSc, Dip IMC, EDTC-II, is a consultant in emergency medicine as well as wound care and hyperbaric medicine at the King Edward VII Memorial Hospital in Bermuda.

He also is a dive medicine consultant for the Bermuda police and government and a dive instructor who works extensively with children.

Water Planet

Life Aquatic

A PERFECT STORM OF WARM The bizarre consequences of a warming world can no longer be ignored

By Allison Vitsky Sallmon, DVM Photos by Andy and Allison Sallmon

Every California diver I know has a recent story about when they first noticed things were changing at our local dive sites. Some recall their local kelp bed looking thin, while others mention the presence of yellowfin tuna on every shore dive, the range extension of a Mexican nudibranch or the appearance of a skinny baby sea lion on the swim step of their dive boat. For me it was when a three-metre-long smooth hammerhead shark curiously bumped my camera rig. It was August 2014, and it was no secret that the surface waters were a few degrees warmer than normal.

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On that day the swell and wind were formidable, but we were determined to get offshore. We hoped to get a good look at the hammerhead sharks – typically a subtropical species – that had been spotted at the surface by one or two multiday dive boats over the past few weeks. We couldn’t believe our luck when one showed up and interacted closely (at times, very closely) with us for three hours.

Among divers the rumoured cause for the oddities of the summer of 2014 was El Niño (the warm phase of the El Niño Southern Oscillation), an ocean-atmosphere interaction in the east-central equatorial Pacific that strongly influences ocean conditions and weather patterns. However, the U.S. National Oceanic and Atmospheric Administration (NOAA) had not confirmed the presence of El Niño conditions.

Meanwhile, Washington state climatologist Nick Bond had already come up with an alternate name for the odd patch of warmer-than-usual ocean off the coast of the Pacific Northwest: “The Blob.” This phenomenon, thought to be the result of locally persistent high pressure that

inhibited normal wind-driven oceanic upwelling and cooling, had spread along the West Coast and encompassed multiple stretches of ocean from Alaska to Mexico.

In some places the ocean’s surface was just under three degrees Celsius warmer than usual. Although the Blob quickly replaced El Niño as the established cause, 2014 diving and fishing reports in Southern California confirmed the effects, each more bizarre than the last.

Tuna fishermen came back from a day offshore east of Catalina Island with images of a whale shark. The lush, iconic kelp of Catalina and San Clemente islands dwindled, and in some places this enabled prolific growth of Sargassum horneri, an invasive alga that better tolerates warmer water. A GoPro video of a manta ray, gracefully flapping among sparse kelp stalks, created a fanatical rush on local dive charters.

By the time NOAA confirmed the arrival of El Niño conditions in March 2015, it was hard to believe that things could get any stranger, but they did. Seabird and California sea lion populations began experiencing devastating dieoffs. In April 2015, strong west-to-east surface winds blew masses of violet-blue Velella velella, open-ocean hydrozoans related to jellyfish, onto beaches in California, Oregon and Washington.

And in June 2015 I watched in amazement as pelagic red tuna crabs (a squat lobster-like crustacean normally found near central Baja California) swarmed one of our few remaining local kelp beds and ultimately littered the coastline from San Diego to Los Angeles.

The peculiarities didn’t stop there. In July and August 2015, smooth hammerhead sharks were bumping near-shore kayak fishermen so commonly and assertively that local beaches were closed on multiple occasions. On the docks, anglers posed proudly next to bluefin tuna, caught only 16 kilometres offshore, and local photographs of finescale triggerfish and Guadalupe cardinalfish became commonplace.

In September 2015, I hovered in disbelief next to the barren propeller of the HMCS Yukon, a San Diego-area artificial reef that had been thickly encrusted with giant plumose anemones only 12 months prior. And only a month after that, a cluster of wahoo passed me at a Catalina Island dive site days before I photographed a pulsing Australian spotted jellyfish near the San Diego harbour. The world – at least, the underwater world I frequented on a regular basis – seemed to have gone stark raving mad.

Ed Parnell, Ph.D., research oceanographer at the Scripps Institution of Oceanography, isn’t terribly surprised to hear it. “The Blob was an unprecedented warm-water event that wasn’t related to common oceanic indices,” he explains. “Last year we had warmer surface conditions, but at depth things remained cold and nutrient-rich, so some deeper species were

less affected than you might think. However, the water became very stratified and more resistant to mixing. Typically, an El Niño pattern results in advection of pulses of warm equatorial water northward, so that upwelled water is warmer than normal and less able to deliver nutrients to shallower structures. But this year, with things prestressed by the Blob, the seasonal thermocline is already deeper than normal, so

A diver pauses over an Australian spotted jellyfish near the coast of San Diego Unusually warm surface waters in California have made it easier to interact with uncommon creatures, such as smooth hammerhead sharks

Water Planet

El Niño may bring a series of storms, but we need to remember that these storms act as a reset button

The propeller of the HCMS Yukon wreck in San Diego’s Wreck Alley was thickly covered with giant plumose anemones in spring 2014. By the summer of 2015, the ocean had become warm enough to wipe them out, leaving nearly bare metal behind

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upwelled water would likely be even warmer than we’ve seen with prior El Niños – in fact, this year upwelling might not deliver much cold, nutrientrich water at all.”

Parnell’s key concern is further overgrowth of invasive Sargassum horneri. “Two years ago, we were seeing isolated pockets of it, but now it’s popping up everywhere,” he says. “If we lose the kelp in an area completely, sargassum can easily take over because it will no longer be suppressed by giant kelp shading.”

Previous El Niño events have delivered mighty topside changes to the West Coast as well. In the past, the position of the jet stream has shifted south and east from the Gulf of Alaska so that storms track closer to the Southern California shoreline. The strong El Niño in 1982–83 brought crippling storm fronts, complete with waves

that broke over the roofs of popular beachside restaurants. And in 1997–98, repeated deluges washed away roads and caused catastrophic mudslides. With California in the midst of a drought, it feels a little ungrateful to admit that stories of the past combined with ever-moreominous nicknames bestowed upon the present El Niño (“Bruce Lee” is my current favourite) are more than a little frightening.

Parnell, however, says this may be one of the biggest reasons to remain optimistic. “Strong storms can revamp the bottom structure, remove urchin barrens and clear out the understory kelps, providing renewed areas for giant kelp to grow,” he says. “El Niño may bring a series of storms, but we need to remember that those large storms act as a reset button for kelp forests in Southern California.”

Dive accidents do happen.

Don’t let your dan coverage expire.

Four days after a Member allowed his DAN coverage to expire, he suffered a severe case of inner ear DCI. A local air ambulance was organised to get him to care quickly

Out of Pocket Expense: $8,000 If he had Renewed his DAN Coverage: $0

www.danap.org

Gear

STORE IT SMART! Whether you dive yearround or take a seasonal break from the sport, here are a few helpful tips for maintaining and storing your gear

PROFESSIONAL SERVICING

n/a

ITEM(S)

BEFORE YOU DIVE

AFTER YOU DIVE

STORAGE

Mask, fins, snorkel

Keep them well organised to minimise risk of being kicked or stepped on

Rinse and dry

Pack and store carefully to avoid having these items crushed by heavier gear

BCD

Check valves, inflator buttons and pressure maintenance

Rinse the outside, and flush the bladder with fresh water. Hang to dry

After drying, partially inflate Test at least once every year jacket for storage. Remove weights from pockets

Regulator

Inspect hoses, filters, connections, pressure, breathability and watertightness

Soak and clean in fresh water while still connected to scuba cylinder and pressurised.

Leave out to dry

Keep dust cap in place, and store in a regulator bag

Service at least once a year

Wetsuit, boots, gloves, hood

Lubricate zippers if necessary

Rinse, turn inside out, and hang to dry.

If wetsuit has an unpleasant odour, use wetsuit shampoo in the postdive rinse tub

Keep out of direct sunlight; neoprene, like most dive gear, is susceptible to UV damage

n/a

Computer

Check battery life and gas settings

Rinse and dry

Store in a dry, cool, ventilated area

Service every one or two years per the manufacturer’s recommendation

Cylinder

Handle with care; pressurised cylinders contain a lot of potential energy. Secure tightly for transportation

Rinse thoroughly and let dry. Regularly remove tank boot to prevent buildup of salt and debris

Never empty of gas completely. Reduce pressure to the lowest you can read on the pressure gauge. Keep a clean, dry dust cap on the valve

Cylinders need a visual inspection once per year and a hydrostatic test every five years

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HERE’S WHAT YOU’RE MISSING IN THIS ISSUE OF

SCUBA DIVER AUSTRALASIA Scuba Diver AUSTRALASIA is the official media partner of DAN Asia-Pacific.

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FROM THE EDITOR As divers we are all in on it: We know that we have access to another dimension.

Descending into the big blue, we’ve all felt it, that we are entering a world full of wonder. Not only are we almost totally freed from the constraints of gravity and able to fly about like aquatic superheroes, but we’re also able to visit places that most landlubbers couldn’t even imagine in their wildest dreams.

These underwater wonderlands take many forms – mysterious mangroves, dramatic ravines, canyons and caves, fields of insanely colourful coral, and reef formations that seem to defy common sense. These seascapes are also inhabited by creatures that are so unexpected, so far out, that they have inspired legends and literature. In this celebration of underwater wonderlands, we invite you to follow us down a watery rabbit hole.

Let us get you up close and personal to the beasts behind the myths (the dugongs and walrusus), to trippy critters that even the Cheshire cat couldn’t have predicted (neon nudibranchs, of course!). Meet the real Moby-Dick (Migaloo), and explore seascapes in Sulawesi that Salvador Dali might have dreamed up. Time to leave reason at the surface.

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By Imran Ahmad

The best diving in Sulawesi is some of the best diving the world has to offer. From melting Salvador Dali sponges to whale sharks and unbelievable muck critters, this is a true wonderland in the water

38 STRAIGHT OUT OF WONDERLAND

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