Diving Emergency Management Provider STUDENT HANDBOOK Diving Emergency Management Provider Student Handbook DAN Medical Information Line: +1 (919) 684-2948 ext. 6222 DAN Emergency Hotline: +1 (919) 684-9111 Authors: Nicholas Bird, MD., MMM; Matias Nochetto, M.D.; Patty Seery, MHS, DMT Contributors and Reviewers: Jim Chimiak, M.D.; Petar Denoble, M.D., D.Sc.; Brian Harper, B.A., W-EMT; Frances Smith, M.S., EMT-P; Scott Smith, EMT-P Editors: Patty Seery, MHS, DMT; Diana Robinson, B.A. This program meets the current recommendations from the October 2015 Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care issued by the International Liaison Council on Resuscitation (ILCOR)/American Heart Association (AHA). 4th Edition, Rev. 2.1, December 2017 ©2017 Divers Alert Network All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means — electronic, mechanical, photocopying or otherwise — without prior written permission of Divers Alert Network, 6 West Colony Place, Durham, NC 27705. 3rd edition published March 2013; 2nd edition published 2006; 1st edition published 2003. Diving Emergency Management Provider TABLE OF CONTENTS Section 1: DEMP Course Overview ........................................................................ 4 Section 2: Basic Life Support: CPR and First Aid .................................................. 6 Review Answers...........................................................................................73 Section 3: Neurological Assessment ..................................................................... 74 Review Answers.........................................................................................107 Section 4: Emergency Oxygen for Scuba Diving Injuries ................................... 108 Review Answers.........................................................................................148 Section 5: First Aid for Hazardous Marine Life Injuries .................................... 150 Review Answers.........................................................................................215 Section 6: Dive Accident Management Preparation ............................................ 216 Review Answers..........................................................................................222 Section 7: Diving Emergency Management Provider Summary.......................... 223 Glossary ............................................................................................................. 224 Diving Emergency Management Provider 3 SECTION 1 Diving Emergency Management Provider Course Overview Dive accidents are rare, but they may require prompt, specific action. No single set of skills will meet all the various demands a dive accident may present. The Diving Emergency Management Provider (DEMP) program combines skills from four first-aid courses offered by your instructor to streamline and put into context the care that may be necessary. Starting with basic life support (Section 2), participants will become familiar with the signs and symptoms associated with cardiovascular diseases such as heart attack as well as with other diseases and conditions that may also pose an immediate threat to life. If there is any question about whether an injury may be present, a neurological assessment (Section 3) may help identify abnormalities that should prompt first-aid care and further evaluation. Oxygen first aid has long been established as the primary first aid for dive accidents. Recognizing the signs and symptoms indicative of decompression illness can facilitate prompt intervention with oxygen therapy, as taught in Emergency Oxygen for Scuba Diving Injuries (Section 4). Finally, at some point most divers will experience injuries, usually minor, from encounters with marine life while diving. Most of these injuries require only simple interventions. Occasionlly, however, more involved first aid is necessary. First Aid for Hazardous Marine Life Injuries (Section 5) covers both general care and more specific interventions that may be required. Successful completion of the Diving Emergency Management Provider course includes demonstrating skill competency and passing a final knowledge assessment for each section of the course. Upon successful completion of the course, you will receive a provider card indicating that you have been trained in cardiopulmonary resuscitation (CPR), use of automatic external defibrillators (AEDs), how to conduct a basic neurological assessment, administration of oxygen for scuba diving and drowning injuries as well as first-aid procedures for injuries caused by marine life. 4 Diving Emergency Management Provider First-Responder Roles and Responsibilities First aid is providing initial care for an injury or illness. The three key aims of first aid are to (1) preserve life, (2) prevent the condition from worsening and (3) promote recovery. All skills performed in an emergency should be within the scope of one’s training. Maintain skills and knowledge proficiency by reading current literature and participating in supervised practice sessions. Talk to your DEMP Instructor for options. Reading this handbook without instruction and skill practice will not make someone competent to provide CPR or first aid in a diving emergency. Course Prerequisites There are no course prerequisites for participation in this course. Some countries, states and local municipalities, however, may have minimum age stipulations for the use of 1 emergency oxygen and/or AEDs. Scuba Certification Scuba diving certification is not a course prerequisite. This course teaches scuba divers and interested nondivers how to provide appropriate first aid to injured divers. Familiarity with diving equipment and diving terminology will make understanding the material easier. Interested and informed nondivers, however, should be able to master the material. Retraining Since emergency-response skills deteriorate with time, retraining is required every two years to maintain the Diving Emergency Management Provider credential. In addition, regular practice is encouraged to retain skill proficiency. Continuing Education Continuing education is encouraged in the form of taking additional training courses, participating in supervised practice sessions, reading current literature and undergoing refresher training. Your DEMP Instructor can provide information about these programs. How To Use This Handbook Each chapter in this student handbook contains three distinct features. • The beginning of each chapter has a list of learning objectives. This is the information you should look for as you read the material, complete the knowledge-development sections and participate in class discussions. • Boxes labeled “Note” provide explanations that are important for understanding the material just presented. • Boxes labeled “Advanced Concepts” contain additional information beyond what is required for this course. It is enrichment for those students who want to know more. Terminology The Diving Emergency Management Provider student handbook introduces medical terms that may be unfamiliar to some readers. Familiarity with basic medical terminology will enhance the quality of communication with emergency and health-care workers. A glossary of terms is provided in the back of this handbook. Diving Emergency Management Provider 5 SECTION 2 Basic Life Support: CPR and First Aid TABLE OF CONTENTS Chapter 1: Basic Life Support: CPR and First Aid Overview .......................7 Chapter 2: Basic Life Support (BLS) ............................................................8 Chapter 3: Respiration and Circulation ....................................................16 Chapter 4: Scene Safety Assessment ..........................................................21 Chapter 5: Initial Assessment and Positioning for Care ............................28 Chapter 6: Cardiopulmonary Resuscitation ..............................................32 Chapter 7: Use of AEDs During CPR .........................................................38 Chapter 8: Foreign-Body Airway Obstruction ...........................................42 Chapter 9: First-Aid Assessments ..............................................................45 Chapter 10: Temperature-Related Injuries ................................................50 Chapter 11: Lifting and Moving ................................................................57 Chapter 12: Basic Life Support: CPR and First Aid Skills Development .....59 Section 2: Basic Life Support: CPR and First Aid Summary ......................71 References ..................................................................................................72 Review Answers .........................................................................................73 6 Diving Emergency Management Provider Basic Life Support: CPR and First Aid Overview 1 According to the World Health Organization, cardiovascular diseases are the most common cause of death worldwide and account for about one-third of deaths.1 As our population ages, the prevalence of these diseases is expected to increase. This program will help prepare participants to handle these events and other life-threatening incidents. The Basic Life Support: CPR and First Aid provider program is designed to provide participants with foundational knowledge and teach skills needed to perform cardiopulmonary resuscitation (CPR) and other lifesaving skills. In