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
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
Posted in Alert Diver Fall Editions, Smart Guides
Tagged with DAN Courses, DEMP, Diving emergency management, O2 providers, First Aid Training, Neurological assessments
Tagged with DAN Courses, DEMP, Diving emergency management, O2 providers, First Aid Training, Neurological assessments
Categories
2021
March
Old Habits Die HardSave a Diver, Save YourselfCylinder SafetyUndercover CrabsReef safe sunscreenPhysics, Biophysics and Decompression SicknessModels and Marine LifeSunscreen and CoralCristina Mittermeier: Commitment to ConservationDiving After a StrokeCurrent DivesThis Bites: Prevention TreatmentEnvironmental Considerations for Disinfection
April
Aqua Pool Noodle ExercisesUnderwater Photographer and DAN Member Madelein Wolfaardt10 Simple Things You Can Do to Improve Your Underwater PhotographyCOVID-19 and Diving: March 2021 UpdateDiver Return After COVID-19 Infection (DRACO): A Longitudinal AssessmentGuidelines for Lifelong Medical Fitness to Dive
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March