DAN Medical Q&A

Ask DAN

DAN medical specialists and researchers answer your dive medicine questions

PFO CONCERNS IN DIVE INJURY MANAGEMENT

Q: I recently took DAN’s online Basic Life Support: CPR and First Aid and Emergency Oxygen for Scuba Diving Injuries courses. I’ve heard it is best to put an injured diver in the recovery position on their left side because of the possibility of a patent foramen ovale (PFO). Is this true, and what would be the benefit?

A: A PFO is undoubtedly a concern with diving because about 25 percent of the population has one. The recovery position supports and maintains an open airway in an unconscious person or injured diver. The left-side preference was based on anatomy, not PFO concern. Blood from the venous system returns to the right atrium via the superior and inferior vena cava, so the idea of putting a diver on the left side was to alleviate unnecessary weight that might compress these large vessels and impede circulation.

Recent studies and recommendations from the International Liaison Committee on Resuscitation (ILCOR), however, suggest there is no benefit to placing someone on their left side instead of their right side when using the recovery position. In the case of suspected decompression sickness (DCS), place the injured diver in a position of comfort, or if they are unconscious, one that allows you to monitor them as necessary.

PFO concern is not a factor in this case. If the diver is symptomatic and you are rendering care, then you need to treat the symptoms. Give them the highest concentration of oxygen available and get them to definitive health care and treatment. Remember that many conditions show symptoms that may mimic DCS. Just because someone was diving does not mean they have a dive-related illness. When creating your emergency action plan, note the location of the nearest emergency room or where and how to access local emergency services.

What is a PFO?

A PFO is a very small hole in the heart (often closed under normal circumstances) and which, during or after diving, can enable nitrogen bubbles to pass back into circulation in the blood rather than being expelled by the lungs, leading to DCI. If a PFO is suspected, the treating physician will often refer the diver to be tested. A negative result on the test does not necessarily mean there is no PFO, however, if one is present it is likely to be very small.

A positive test indicates there is an obvious route that bubbles in the venous blood can pass through the heart and enter the arterial blood, from where it can be taken to the brain, spine and elsewhere in the body. The PFO can often be repaired surgically, and some divers elect to have the hole closed. As with any surgical procedure there are associated risks and these need to be balanced against the desire to continue diving and the risk of diving without having the PFO repaired. Many divers continue to dive despite a small PFO and reduce the chances of a problem by limiting depths, repetitive diving, extending surface intervals, doing slow ascents and safety stops and using nitrox (with dive times based on air). DANAP.org

Monthly round-up of news from our SSI dive centres and professionals www.divessi.com

As the world is opening up

to travel, and Australia is opening up to each state and international travel, we can expect to see a return to a new normal. We will be able to visit our favourite tropical destinations and the beautiful reefs of Far North Queensland will be back on the agenda for the rest of Australia! Exciting times ahead!

This being said, SSI has recognised that through the COVID pandemic, many Dive Professionals either returned to their home country or perhaps even moved into a new career path. This has left a shortage of SSI Dive Professionals globally. We saw that this was potentially an issue at the start of 2021 and launched our ‘We Want You’ campaign. This gained us over 3000 new SSI Professionals worldwide!

Now we are expanding this campaign to the ‘We Want You Pro initiative”

This is how it will work: • SSI Dive Centres list all of their upcoming

Pro courses for the next 12 months into their

Centre ‘Events’ calendars • SSI HQ have created ‘Push’ marketing promoting these upcoming courses to all recreational divers and Dive Professionals.

These divers will be directed to the courses conducted by their affiliated Dive Centres. - Divers certified in Stress and Rescue will be directed to upcoming dates for the Dive Guide program with the call to action ‘Become a Divemaster’. - Divemasters will be sent upcoming dates for Assistant

Instructor and Instructor Training Courses. - Divemaster Instructors who fulfil the pre-requisites for Assistant Instructor Trainer will receive Instructor

Trainer Seminar dates with the call to action ‘Become an

Instructor Trainer’.

Our goal – to fill our SSI Dive Centres Pro training schedules!

To add to this initiative we have an added benefit for our Dive Professionals who conduct this Pro Training!

It is that time of year again when Dive Professionals and Dive Centres are requested to renew their membership for the 2022 period. As always, SSI are looking at ways to support our loyal customers. SSI Instructors receive reward points for every student that they certify, this includes those that are registered for ‘Try Dives’. These reward points can be used against their SSI renewal fee OR to purchase SSI professional digital kits to upgrade their Instructor specialty ratings. This can be a significant saving on renewal fees at the end of the year, with many Instructors having no fee whatsoever.

This year, to sweeten the deal, from 15 October, SSI Pros will receive the equivalent of 20€ in their reward points for each Dive professional that they certify! This should greatly alter the renewal fees for those pros that participate!

Instructor Trainer Seminars are coming up!

The SSI Instructor Trainer is the highest recreational trainer rating in the SSI system. It is the greatest achievement that an SSI pro can aspire to!

After an uncertain 2020 and a bumpy 2021, we will be running TWO Instructor Trainer Seminars in 2022! This will be an application process and any Divemaster Instructors wanting to join ‘The best of the best’ will be invited to apply.

The dates: 23 May – 3 June - NSW hosted by Pro Dive Central Coast.

For any information in regards to any of our SSI programmes, promotions or renewal process, please contact our friendly customer service team. n