Research and Outreach

CREDITS | Text by Jill Heinerth
Your research saves lives, and your outreach efforts inform an entire community about safe
diving practices,” I recently wrote to DAN® research director Neal Pollock, Ph.D. I penned the letter after a long day in Newfoundland, Canada, that began with a stunning dive on a World War II shipwreck and ended with a friend taking an ambulance ride to the Health Sciences Center in St. John’s.
DAN had been there for me before in the most classic sense. More than 15 years ago I was hit with a case of decompression illness (DCI) while exploring new cave passages in Mexico at a now famous site called The Pit. With assistance from DAN, I received a necessary hyperbaric chamber treatment and all the requisite follow-up care. But this time it was DAN’s research and
educational outreach that made the difference for my diving group. Both Pollock and hyperbaric medicine researcher Stefanie Martina had been filling my inbox with informative medical articles since we worked together on an expedition a few months earlier. In Pollock’s words, “Data we gather on these projects is important, but our opportunity for outreach is priceless.”
When my diving friend motioned for help beside our boat in Conception Bay, Newfoundland, the entire crew and our group of seasoned divers leapt into action. He was gasping for breath with a rattling gurgle, pulling at his neck seal, desperately trying to say, “I can’t breathe!”
Within minutes, we had the victim, a very experienced technical diver, seated on deck and were removing his drysuit and dive gear. He coughed bloody froth into a bucket while we provided oxygen and supportive care. Some might have guessed this was an embolism or “chokes,” and others might have passed it off as an event of uncharacteristic panic, but knowing that this accomplished veteran had managed to suffer through 17 agonizing minutes of decompression and ascend at a normal rate led me to conclude that he was experiencing a little known malady I had recently read about and had witnessed before. His rapid improvement further corroborated my theory that he was experiencing immersion pulmonary edema (IPE).
IPE, which is abnormal leakage of fluid from the bloodstream into the alveoli during immersion, can occur in anyone immersed in water, even swimmers. The injured swimmer or diver develops a cough, has difficulty breathing, develops raspy breathing and often spits up frothy, blood-tinged liquid from the lungs. The symptoms may suddenly become acute when the person surfaces, because this represents the point of greatest ambient pressure differential between the mouth and the chest. IPE has been reported in healthy, young individuals such
as triathletes and combat swimmers as well as across the entire spectrum of the diving community, including people with reported heart and lung conditions. The onset may be
very rapid or may develop over time and can even worsen over the course of daily, repeated immersion. During immersion, especially in cold water, blood is redistributed from the extremities to the lungs. When the victim is no longer in the water this edema gradually subsides.
When a diver or swimmer has difficulty breathing, they may panic, aspirate water and possibly drown. A diver may skip decompression obligations or ascend rapidly and experience additional barotrauma. For this reason, and because the symptoms can resolve rapidly once the diver is out of the water (often before reaching the dock or hospital), this phenomenon may
be underreported and often misdiagnosed. Whether considered a panic attack or a result of ill-fitting or malfunctioning gear, cases of IPE may be completely overlooked. Despite the fact that our boat included safety officers, first responders, dive instructors and other experts, few of them had ever heard of IPE.
Studies have revealed that several external factors, including cold water, exercise and high work of breathing, may create the perfect IPE scenario. Numerous internal factors, such as hypertension, other cardiac issues, cardiovascular disease and excessive hydration, may also increase the likelihood of experiencing IPE. Some people seem to be susceptible to IPE; these people include, surprisingly, elite athletes as well as people with known cardiac and pulmonary issues. IPE is diagnosed by exclusion (ruling out other possibilities), so it is vital that anyone experiencing symptoms seeks immediate medical attention. Other conditions that could cause similar symptoms, such as a heart attack or DCI, need to be considered first.
Hyperbaric treatment is not needed for IPE, and symptoms generally resolve completely in 24-48 hours. Follow-up care involves medical assessment by a physician (one trained in dive medicine, if possible) who can rule out any other issues that need addressing and look for conditions that may contribute to future IPE susceptibility before recommending a return to diving.
I’m happy to report that within six hours of the emergency’s onset, our victim transitioned from his dive accident to socializing with friends at the end of a long day. In between was an evacuation, an ambulance ride, an emergency room assessment, tests and a visit with a hyperbaric specialist. It was great to have a good ending to this very serious event, being in the company of good dive buddies, who all played an important role in our friend’s rescue and treatment.
Another positive aspect of this experience was the realization that we were properly prepared to handle a diving emergency. The boat crew were well trained and equipped with oxygen and first-aid equipment. Rescuers stayed calm and levelheaded, as did the victim, who got himself safely to the surface without missing his decompression obligations or making a rapid ascent.
This incident highlights the importance of training, diving research and education. It is foolish, in my experienced opinion, to dive without DAN dive accident insurance; even if you never use it, you will be supporting important work that helps our community better understand and mitigate diving risks. AD
Your research saves lives, and your outreach efforts inform an entire community about safe
diving practices,” I recently wrote to DAN® research director Neal Pollock, Ph.D. I penned the letter after a long day in Newfoundland, Canada, that began with a stunning dive on a World War II shipwreck and ended with a friend taking an ambulance ride to the Health Sciences Center in St. John’s.
DAN had been there for me before in the most classic sense. More than 15 years ago I was hit with a case of decompression illness (DCI) while exploring new cave passages in Mexico at a now famous site called The Pit. With assistance from DAN, I received a necessary hyperbaric chamber treatment and all the requisite follow-up care. But this time it was DAN’s research and
educational outreach that made the difference for my diving group. Both Pollock and hyperbaric medicine researcher Stefanie Martina had been filling my inbox with informative medical articles since we worked together on an expedition a few months earlier. In Pollock’s words, “Data we gather on these projects is important, but our opportunity for outreach is priceless.”
When my diving friend motioned for help beside our boat in Conception Bay, Newfoundland, the entire crew and our group of seasoned divers leapt into action. He was gasping for breath with a rattling gurgle, pulling at his neck seal, desperately trying to say, “I can’t breathe!”
Within minutes, we had the victim, a very experienced technical diver, seated on deck and were removing his drysuit and dive gear. He coughed bloody froth into a bucket while we provided oxygen and supportive care. Some might have guessed this was an embolism or “chokes,” and others might have passed it off as an event of uncharacteristic panic, but knowing that this accomplished veteran had managed to suffer through 17 agonizing minutes of decompression and ascend at a normal rate led me to conclude that he was experiencing a little known malady I had recently read about and had witnessed before. His rapid improvement further corroborated my theory that he was experiencing immersion pulmonary edema (IPE).
IPE, which is abnormal leakage of fluid from the bloodstream into the alveoli during immersion, can occur in anyone immersed in water, even swimmers. The injured swimmer or diver develops a cough, has difficulty breathing, develops raspy breathing and often spits up frothy, blood-tinged liquid from the lungs. The symptoms may suddenly become acute when the person surfaces, because this represents the point of greatest ambient pressure differential between the mouth and the chest. IPE has been reported in healthy, young individuals such
as triathletes and combat swimmers as well as across the entire spectrum of the diving community, including people with reported heart and lung conditions. The onset may be
very rapid or may develop over time and can even worsen over the course of daily, repeated immersion. During immersion, especially in cold water, blood is redistributed from the extremities to the lungs. When the victim is no longer in the water this edema gradually subsides.
When a diver or swimmer has difficulty breathing, they may panic, aspirate water and possibly drown. A diver may skip decompression obligations or ascend rapidly and experience additional barotrauma. For this reason, and because the symptoms can resolve rapidly once the diver is out of the water (often before reaching the dock or hospital), this phenomenon may
be underreported and often misdiagnosed. Whether considered a panic attack or a result of ill-fitting or malfunctioning gear, cases of IPE may be completely overlooked. Despite the fact that our boat included safety officers, first responders, dive instructors and other experts, few of them had ever heard of IPE.
Studies have revealed that several external factors, including cold water, exercise and high work of breathing, may create the perfect IPE scenario. Numerous internal factors, such as hypertension, other cardiac issues, cardiovascular disease and excessive hydration, may also increase the likelihood of experiencing IPE. Some people seem to be susceptible to IPE; these people include, surprisingly, elite athletes as well as people with known cardiac and pulmonary issues. IPE is diagnosed by exclusion (ruling out other possibilities), so it is vital that anyone experiencing symptoms seeks immediate medical attention. Other conditions that could cause similar symptoms, such as a heart attack or DCI, need to be considered first.
Hyperbaric treatment is not needed for IPE, and symptoms generally resolve completely in 24-48 hours. Follow-up care involves medical assessment by a physician (one trained in dive medicine, if possible) who can rule out any other issues that need addressing and look for conditions that may contribute to future IPE susceptibility before recommending a return to diving.
I’m happy to report that within six hours of the emergency’s onset, our victim transitioned from his dive accident to socializing with friends at the end of a long day. In between was an evacuation, an ambulance ride, an emergency room assessment, tests and a visit with a hyperbaric specialist. It was great to have a good ending to this very serious event, being in the company of good dive buddies, who all played an important role in our friend’s rescue and treatment.
Another positive aspect of this experience was the realization that we were properly prepared to handle a diving emergency. The boat crew were well trained and equipped with oxygen and first-aid equipment. Rescuers stayed calm and levelheaded, as did the victim, who got himself safely to the surface without missing his decompression obligations or making a rapid ascent.
This incident highlights the importance of training, diving research and education. It is foolish, in my experienced opinion, to dive without DAN dive accident insurance; even if you never use it, you will be supporting important work that helps our community better understand and mitigate diving risks. AD
Posted in Alert Diver Fall Editions
Tagged with Dive Research, Outreach, Diver Health, Hyperbarics, Dyperbaric medicines, Pulmonary Edema, Ultrsound
Tagged with Dive Research, Outreach, Diver Health, Hyperbarics, Dyperbaric medicines, Pulmonary Edema, Ultrsound
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2020
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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
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May
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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
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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
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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
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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
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