Sight Search

Trouble In Galápgos

By Ben Strelnick, NREMT, W-EMT
DAN Emergency Services received a call via satellite phone from a liveaboard anchored off a remote island in the Galápagos. A DAN member was concerned about their bunkmate exhibiting symptoms following the day’s dive activities. The diver had completed four dives that day. Although she began to show signs following the second dive, the inexperienced diver wrote off her symptoms, did not seek help, and continued diving.

There were no significant events on any of the simple, recreational dives. Still, there was a current on the surface, and the diver assumed her shoulder pain was from the exertion required to get back to the boat. The diver denied shortness of breath, breath holds, and buoyancy or equalisation issues.

Her dive buddy was the divemaster, who told her on the fourth dive to surface without completing the decompression obligation on the diver’s computer. According to information provided to DAN, the divemaster’s computer had different decompression obligations.

The diver had a total of 40-lifetime dives and was completing an advanced open-water certification. She was using rented equipment and was not familiar with the dive computer.
When DAN medics received the call, the diver complained of pain under her left breast and in her left shoulder, numbness in her right leg, a brief loss of consciousness, nausea, and cutis marmorata (skin marbling) on her  abdomen, back, and legs. Both the diver and the crew, however, seemed unconcerned.

DAN medics quickly realized that the situation might be dire. The symptoms and time frame fit the suspected decompression sickness (DCS) profile. The signs and the missed 18-minute decompression obligation meant that the situation was serious and needed a quick response.
DAN recommended that the crew immediately activate their emergency action plan (EAP) and get the diver to definitive care. They started surface-level oxygen, but the vessel’s remote location meant they were roughly 18 to 20 hours from the closest medical facility.

A speedboat was dispatched from the mainland to rendezvous with the vessel en route. However, the speedboat’s trip out would still take five hours, with another five hours to return to port and make the transfer to local emergency services.

While rescue operations were underway, the diver’s condition continued to deteriorate. Her symptoms worsened, and she was in and out of consciousness. When conscious, she was in severe pain. The diver was numb in both legs and unable to urinate. Her vision became severely affected. With time becoming an increasingly important factor, the Ecuadorian Navy dispatched a helicopter to expedite the trip.

DAN medics were in contact with the receiving physician, and the diver arrived at the facility in bad shape. She was disoriented, in hypovolemic shock, and had skin lesions and signs of spinal cord and brain injury. Luckily, she gradually improved with treatment.
 
Her dive profiles for the day were the following:

  • 81 feet, 54 minutes, 30 percent enriched air nitrox (EAN), safety stop completed, surface interval of 1.5 hours
  • 87 feet, 50 minutes, 30 percent EAN, safety stop completed, surface interval of 1.5 hours
  • 89 feet, 54 minutes, 30 percent EAN, safety stop completed, surface interval of 1.5 hours
  • 78 feet, 57 minutes, 30 percent EAN, safety stop completed, 18-minute decompression obligation not completed

Some divers may erroneously consider these normal recreational dives, but these profiles are aggressive. Four dives in one day are a lot for anyone, and these dives are deep. Not completing decompression contributed to this serious DCS event.
 
Following your dive computer’s recommendation doesn’t mean that you are safe and that any DCS while diving within parameters is undeserved. A dive computer is only a guide, not a wonder device that can measure inert gas loading in an individual. We are all physiologically different, and many factors contribute to DCS. Your dive computer can only try to quantify inert gas loading based on theoretical science. What works for some individuals does not work for others, and there is a risk every time we get in the water. In this case, the diver also ignored DCS symptoms after her second dive and did not follow the dive computer’s recommended decompression.

There are many takeaways from this incident. For starters, never write off symptoms that manifest after diving. If you dive with a computer, follow its recommendations and warnings. Know the difference between no decompression limit (NDL) and decompression diving, and don’t miss your decompression obligation.

Inert gas loading occurs because of depth and time. The longer we spend at depth, the more inert gas we accumulate. While a dive computer is a useful tracking tool, it doesn’t know anything about your overall health, the dive conditions, or any other factors that affect decompression stress. The closer you get to the NDL, the more inert gas builds up in your tissues, and that increased exposure also increases your DCS risk. More conservative dive planning is the only way to mitigate that risk.
 
If you are renting a dive computer or are unfamiliar with the one you are using, do your research. Many user manuals are available online from the manufacturer. Read the manual and know how to use your computer, as you should with all your dive equipment. If you have questions, ensure you get the answers before diving. Never rely on your friend’s dive computer. Each diver should follow their own computer.

A comprehensive refresher course can help you better understand the importance of decompression and how the dive computer plays an essential role in determining your critical safety stops.

Knowing the basics of recognising and treating DCS is essential, particularly before diving aggressively in a remote location with little or no medical support. Whether a lack of knowledge or other factors contributed to this diver’s denial, ignoring symptoms can turn a mild injury that is easy to manage onsite into a severe episode that requires an emergency response and can result in paralysis or death. That kind of situation impacts the diver, everyone on the dive boat, and everyone involved in a potentially hazardous, remote rescue.

Always know what you are getting into, especially with a favourite but remote dive destination. What sort of EAPs does your dive operator have in place? Do they have enough resources on board? Do you know how long a rescue operation would take? What is the plan in case a rescue becomes necessary? What is the difference between rescue and evacuation, and when do those actions occur? These are all things to consider before diving, and it is the diver’s responsibility to know this information as part of their personal EAP.

Categories

 2022
immersion and bubble formation 232bar AGE AIDA Accident management Accidents Acid reflux Acute ailments Advanced courses Rescue diver Aerobic exercise After anaesthesia Aged divers Air Quality Air consumption Air exchange centre Air hose failure Air supply Airway control Air Alert Diver December 2022 Alert Diver Magazine Algorithms Alice Cattaneo Alice Modolo Alternate Airsources use Alternater Air Source Alternative gas mix Altitude changes Altitude diving Altitude sickness Aluminium Oxide Ama divers Amino acids Amos Nachoum Anaerobic Metabolism Anilao Animal life Annual renewal Antarctica Anxiety Apea Apex predators Apnea Apnoea Aqua corps Aquatic creatures Aquatic life Aquatics and Scuba Diving Archaeology Argonaut octopus Argonauts Argon Arrythmia Arterial Gas Embolisms Arterial gas embolism Arthroscopic surgery Aspirin Audible signals Aurel hygiene Australian Flat backed Australia Aviation o2 BCD BHP BLS BWARF Baacterial infections Back adjustment Back pain Back treatment Backextensors Backmount CCR Badages Bag valve mask Bahamas Bail out cylinder Balancing Bandaids Barbell back squat Barometric pressure Barotrauma Basic Life Support Basslets Batteries Beach entry Beached coral Becky Kaga Schott Becky Kagan Schott Beluga whales Bench press Bends Benign prostate hyperplasia Benzophenones Beth Neale Beyond Standards Big Sur Bilikiki Tours Biophysics Black Water Photography Black Blood flow Blood pressure Blood thinners Blue Desert Blue Wilderness Blue economy Blue heron Bridge Blurred vision Boat diving Boat safety Bobbit worm Boesmans gat Boesmansgat Bonaire Bone fractures Bouyancy compensators Bouyancy controls Boyle's Law Boyle\'s Law Bradycardia Brain Brandon Cole Breast Cancer Breath Hold Diving Breath hold diver Breath holding Breath hold Breath-hold Breathing Gas Breathing gas contamination Breathing oxygen Breathing Breathold diving Bright Bank Broken bones Bruising Bubble detection Bubbleformation Buddy Exercise Buddy checks Buoyancy Burnshield CCR CE markings CGASA CMAS CO2 COVID-19 Updates COVID-19 COVID CPR Cabin pressure Caissons diseas California Camera equipment Camera settings Cameras Cancer Remission Cancer treatments Cancer Cannabis and diving Cannabis Cape Town Dive Festival Cape Town Dive Sites Cape Town CapeTown Carbon Monoxide Carbon dioxide Cardiac research Cardiaccompromise Cardio health Cardiological Cardiomyopathy Caribbean Carmel Bay Carribean Conservation Catalina Island Cave diving Cave exploration Caves Cave Cenotes Ceotes Challenging Environments Chamber Safety Chamber science Chamber treatment Charging batteries Charles' Law Charles\' Law Charles\\\' Law Charles\\\\\\\' Law Charles\\\\\\\\\\\\\\\' Law Charlie Warland Chemotherapy Chest compressions Children diving Chiropractic Chlorophll Chokka Run Christina Mittermeier Citizen Conservation Citizen sciences Citizen science Clean Air Cleaning products Climate change Closed Circuit Rebreathers Closed Circuit Rebreather Cmmunity partnership Coastal diving Coastalexcursion Cold Water Cold care Cold sores ColdWater Cold Commercial Fishing Commercial diving Commercial schools Common consideration Common understanding Communication Composition Compressed Air Compressed gas Compressor operators Compressors Concussion Congestive heart Faiture Consercation Conservation Photographer Conservation photography Conservation Contact lenses Contaminants Contaminated air Coping with cold Coral Bleaching event Coral Conservation Coral Reefs Coral Restoration Coral bleaching Coral preservation CoralGroupers Corals Core strength Corona virus Coro Coservation Costamed Chamber Courtactions Cozumel Cradiac valvular Cristina Mittermeier Crohns disease Crowns Crystal build up Crystallizing hoses Cubs Cutaneous decompression Cutting tools Cylinder Ruptures Cylinder capacity Cylinder handwheel Cylinder safety Cylinder valves Cylinder weight Cylinders DAN Courses DAN Europe DAN Profile DAN Researchers DAN medics DAN members DAN report DANTraining DCI DCS Decompressions sickness DCS theories DCS DEMP DM training DNA DReams DSMB Daan verhoeven Dahab Dalton's Law Dalton\'s Law Dalton\\\'s Law Dalton\\\\\\\'s Law Dalton\\\\\\\\\\\\\\\'s Law Danel Wenzel Dangerous Marinelife Dauin island Dave McCowan David Doubilet Dean's Blue Hole Dean\'s Blue Hole Deco dives Decompression Illness Decompression Sickness Decompression Stress Decompression chamber Decompression illsnes Decompression ilness Decompression limits Decompression treatment Decompression Decorator crabs Deep Freediving Deep diving Deep water exploration Deepest SCUBA Dive Delayed Offgassing Dental Depth limits Dever Health Diadema Response Team Diagnosis Diaphragms Diopter Discomfort Diseases Disinfection Disorientation Distraction Dive Buddy Dive Chamber Dive Chmber Dive Computer Dive Destinations Dive Destination Dive H Dive Industry Dive Instruction Dive Instructor Dive Lights Dive Medical Form Dive Medical Dive Practices Dive Professionals Dive Pros Dive Rescue Dive Research Dive Safari Dive Safety Tips Dive South Africa Dive Training Dive Travel Wakatobi Dive Travel Dive accidents Dive buddies Dive caves Dive computers Dive courses Dive cover Dive cylinder Aluminium Dive equipment Dive excursions Dive exercise Dive exeriences Dive experience Dive fitness Dive gear Dive heallth Dive health Dive in Africa Dive insurance Dive medical insurance Dive medicals Dive medicines Dive medicine Dive operators Dive opportunities Dive planning Dive procedures Dive safety 101 Dive safety Dive safe Dive skills Dive staff Dive travels DiveLIVE DiveTravel Diveleader training Diveleaders Diver Food Diver Health Diver Profile Diver Travel Diver education Diver infliencers Diver on surface Diver recall Diverover 50 Divers Alert Diversafety Divesites Diving Divas Diving Family Diving Fatalities Diving Feet Diving Helmets Diving Kids Diving Programs Diving Trauma Diving career Diving emergencies Diving emergency management Diving fit Diving guidelines Diving history Diving injuries Diving science Diving suspended Diving Dizziness Dolphins Domestic Donation Doug Perrine Dowels Dr Rob Schneider Drift diving Drysuit diving Drysuit valves Drysuits Dynamic environment Dyperbaric medicines EAPs EAP EMS EN standards Ear barotrauma Ear pressure Ear wax Ears injuries Eco friendly Ecowise Education Electronic Embolisms Emergency Action Plan Emergency Planning Emergency action planning Emergency decompression Emergency plans Emergency treatments Emergency underwater Oxygen Recompression Emergency Endurance Entry Envenomations Enviromental Protection Environmental factors Environmental impact Environmental managment Environmental stewardship Equalisation Equalization Equipment care Equipment failure Equipment inspection Equipment significance Evacuations Evacuation Evaluations Even Breath Evironmetaly friendly Exercise Exercising Exhaustion Exposure Protection Extended divetime Extinction Extinguisher Extreme treatments Eye injuries FAQ Face computer Factor V Leiden Failures FalseBay Diving Fatigue Faulty equipment Feet Femal diver Female divers Fenivir Fetus development Filling stations Fillings Fin Foot Fins Fire Coral Fire Safety Fire extinguisher Firefighting First Aid Equipment First Aid Kit First Aid Trainig First Aid Training First Aid kits First Aid Fish Identification Fish Life Fish Fit to dive Fitness Levels Fitness Training Fitness evaluation Fitness to dive Fitnesstrainng Fitness Flying Focus lights Food Footissues Foundations Fractures Francesca Diaco Francois Burman Fred Buyle Fredive Free Student cover Free diving Free flow Freedive Competition Rules Freedive Competiton Freedive INstructor Freedive Safety Freedive Training Freedive computer Freedive rescue procedures Freediver Freedive Freediving Instructors Freediving performance Freediving Fur rade Galapagos Gar Waterman Gardens of The Queen Gas Density Gas Planning Gas consumption Gas emboli Gas laws Gas mixes GasPerformance Gasblends Gases Gass bubbles Gastoeusophagus Gastric bypass Gastroenterologist Gas Gear Servicing Germs Geyer Bank Giant Kelp Forest Giant Kelp Giant stride Girls that Scba Gobies Golden fish Gordon Hiles Great White Sharks Green sea turtle Green turles Greenlings Guinness World Record Gutt irritations HBOT HCV HELP HIRA HMLI HMS Britanica Haemorhoid treatment Hand signals Harry Chammas Havanna Hawaii Hawksbill Hazard Description Hazardous Marine life Hazardous marinelife Head injuries Headaches Health practitioner Healthy Food Heart Attack Heart Health Heart Rate monitor Heart fitness Heart rates Heart rate Heart Heat loss Heat stress Heliox Helium Gas Helium Hematoma Hemodynamic Hepatitis C Hepatitus B Hiatal Hernia High Pressure vessels High pressure hoses High temperatures Hip strength Hip surgery Hippocampus History Hole in the heart Hood Hot Humans Hydrate Hydration Hydrogen Hydroids Hydrostatic pressure Hygiene Hyperbaric Chamber Hyperbaric Oxygen Treatments Hyperbaric Oxygen Hyperbaric research Hyperbaric treatment Hyperbarics Hypertension Hypothermia Hypoxia I-52 found INclusivity IdentiFin Imaging Immersion Immine systems In Water Recompression Increased pressure Indemnity form Indian Ocean Indigo SCuba Indonesia Inert gas Infections Infra red Imaging Injections Inner ear Instinct Instruction Instructors Insulation Insurance policy Insurance Integrated Physiology International travel International Internship programs Internship Interval training Irritation Irukandji Syndrome Isotta housing Itchy Rash Its OK Jellyfish Jill Heinerth Joanna Wyrebek Joint pain Journal for Technical Diving Junior Open Water Diver KZN South Coast KZN Karen van den Oever Kate Jonker KateJonker Kenya Kidneys Kids scubadiver Komati Springs KwaZulu Natal LED lights Labour laws Lake Huron Lara Lambiase Laryngospasm Lauren Arthur Learning to dive Leatherbacks Leatherback Legal Network Legal advice Legislation Lembeh Straights Lenses Leslie Lwaney Leukemis Liability Risks Liability releases Liability Life expectancy Lifestyle Lighting Lightroom editing Lionfish Live aboard diving Liveaboard Liver Toxicity Liver diseas Liz Louw Loss of consciousness Lost at sea Low Visability Low blood pressure Low pressure deterioration Low volume masks Lumpsuckers Lung Irritation Lung flexibility Lung function Lung injuries Lung squeeze Lung surgery Lung MOD MOzambique diving MPA Macro photography Mafia Island Maintenance Malaria Mammalian Dive Response Mammalian effect Manatees Mandarin Fish Marfan syndrome Marine Biologist Marine Biology Marine Mega fauna Marine Science Marine Scientists Marine conservation Marine parks Marine plants Marinelife Marinescience Markus Dirschi Marlin Marne protecte areas Mask clearing Masks Master scuba diver Matty Smith Maximum operating depth Medical Q Medical emergencies Medical oxygen Medical questionaire Medical statement Medical team Medicalresearch Medicalstudents Medication Mehgan Heaney-Grier Membership benefits Menopause Menstruation Mermaid Danii Mesophotic Metotrexate Mexico Michael Aw Micro Photography Microbubbles Middle ear pressure Mike Bartick Military front press Misool Resort Raja Ampat Mixed Gas Mono Fins Mooring lines More pressure Motion sickness Motionsickness Mount Kilimanjaro Mozambique Muck Diving Muscle pain Mycobacterium marinum NDL limits Narcosis National Geographic Nature Nausea Nautilus Ndibranchs Neck pain Neoprene layers Neuro assessments Neurocognitive research Neurological assessments Neuromotor exercises New Caledonia Nichola Bird Nicorette Nicotine Nitrogen Narcosis Nitrogen build up Nitrox No Decompression Limits No-decompression limits No-decompression Non-nano zinc oxide Non-rebreather Mask Non-smoking Nondiving related illness Nonrebreather masks Normal Air North Sulawesi Nosebleeds Nudibranchs Nuno Gomes Nutrition O2 enriched O2 oxygen provider. O2 providers O2 servicing O2treatments OOxygen maintenance Ocean Projects Ocean Research Ocean animals Ocean conservation Ocean mammals Ocean migrations Ocean pollution Oceangate Octopus Oil contamination Olive Ridley Open Ocean Open water divers Optical focus Oral contraseptives Orbital implants Oronasal mask Osteonecrosis Otters Out and about Out of air Outer ears Outreach Overhead Envirenments Oxygen Administration Oxygen Cylinder Oxygen Units Oxygen deficit Oxygen deicit Oxygen dificiency Oxygen ears Oxygen equipment Oxygen kit Oxygen masks Oxygen providers Oxygen supplies Oxygen supply Oxygen systems Oxygen therapy Oxygen treatment Oxygen P J Prinsloo PADI Freedivers PFI PFO PJP Tech Paper Nautilus Paralysis Parentalsupervision Part 3 Partner Training Patent foramen ovale Pemba Island Peri-peri Divers Perspective Peter Lindholm Philippine Islands Philippines Phillipines Photographers Photographer Photography tips Photography Physical Fitness Physioball Physiology Physiotherapy Pills Pilot Whale Pistons Planning Plastic Plimsoll Interface Pneumonia Pneumothorax Poison Polka Dot Bat fish Pollution Pool Diving Pool chemicals Pool maintenance Pool workout Pools Post-dive Potuguese man-of-war Pre-dive Predive check Pregnancy Pregnant divers Preparation Prepared diver Press Release Preventions ProDive Port Elizabeth Professional rights Protection Provider course Psycological Pulmanologist Pulmonary Barotrauma Pulmonary Bleb Pulmonary Edema Pulmonary Hypertension Pulse Punture wounds Pure Air Pure Apnea Purge Quit Smoking Q RAID South Africa RCAP REEF RMV Radio communications Range of motion Rashes Rebreather diving Rebreatherdive Rechargeable batteries. Recompression chamber Recompression treatment Recompression Recycle Red SEA Reef Chcek Reef Conservation Reef Environmental Education Foundation Reef protection Reef safe Reef surveyors Refractive correction Regal Sea Goddesses Regulator failure Regulators Regulator Remote areas Remote islands Renewable Report incidents Rescue Divers Rescue Procedure Rescue breathing Rescue breaths Rescue diver Rescue skills Rescue skill Rescue training Rescue Research Respitory Minute Volume Resume diving Return To Diving Return to diving Reuseable items Risk Assessments Risk assesments Risk assessment Risk elements Risk management Risks of Seizures Riviera Maya Roatan Marine Park Roatan SABS 019 SAC SMB SRC SafariLive Safe diving practices Safety Concerns Safety Gear Safety Stop Safety in Air Safety SaherSafe Barrier Salish Seas Salty Wanderer Sanitising Sanne Volja Sara Andreotti Sara Banderby Sara Campbell Sardine Run Sargassum sea Saturation Diving Save our seas Schrimps Science Scoliosis Scombroid Poisoning Scorpion Fish Scuba Air Quality Scuba Guru Scuba Injury Scuba Instructor Scuba children Scuba divers Scuba dive Scuba education Scuba health Scubalearners Scubalife Sea Horses Sea Turtles Sea slugs Seagrass Sealcolonies Sealife Seals Seasickness Seaweeds Seaweed Sea Self Rescue Shallow Water Blackout Shallow dives Shark Protection Shark Research Shark conservation Shark diving Sharks Shipwrecks Shit Happens Shore entries Shoulder strength Sidemount Sideplank Signs and Symptoms Silty bottoms Sit-ups Sixgill Sharks Skills in action Skin Bends Skin outbreak Skin rash Smart phone photography Snells Window Snorkeling Snorkels Social Distancing Sodwana Bay Solomon Islands Sonnier bank South Africa Southern Sea Otters SpareAir Sperm Whales Spinal Bend Spinal bends Spinal cord DCS Spinal dura Spinal pain Spinner dolphins Spleen Splits Sports medicine Squeezes Squid Run Stability exercise Stage cylinder Standars Statin Mediction Stay Fit Stay Warm Steel Stefan Randig Stents Step ups Stephen Frink Stepping up Stockton Rush Stonetown Stretch band exercise Stretch bands Strobe Lighting Strobes Stroke Submerge tech Submerged Sudafed Sulawesi Sun protection Sun screen Sunscreen Supplemental oxygen Surface Air Consumption Surface Consumption Rate Surface Marker Buoys Surface supplied Air Surfaced Surgeries Surgery Suspension training Swim Fitness Swimmers health SwimmingIn wateractivities Swimming Sylvia Earl Symbiosis Symbiosys TRavel safety Tabata protocol Talya Davidoff Tanzania Tattoes Tec Clark Tech diving Technical Diving Technical divng Temperature Homeostatis The Bends The Cavettes The Titanic Wreck The Wild Coast The greatest Shoal The silent world The truth Thermal Notions Thermoregulation Thomas Peschak Thunder Bay National Marine Sanctuary Tides Tips and trick Tonga Tooth squeeze Transplants Travel destinations Travel smarter Travel tips Travel Tropical Coastal Management Tulamben Tullum Tulum. Tunnelling Turks and Caicos Turtles Tweezers Ultrsound Umkomaas Unconscious diver Unconsciousness Underground waterways Underground work Underseaa world Underwaater Photos Underwater Photography Underwater Photograper Underwater Photograpgraphy Underwater Photographer Manirelife Underwater Research Underwater camera Underwater critters Underwater floral Gardens Underwater hockey Underwater imaging Underwater photographer Underwater photography Underwater photos Underwater pho Underwater sound Underwatercommunications Underwater University of Stellenbosch Unresponsive Urchins Urinary retention. VGE Vacations Vaccines Vagus nerve Valsalva manoeuvers Valve stem seals Vape Vaping Vasopressors Vasvagal Syncope Venous gas emboli Ventilate Venting Verna van Schak Veterinarian Videography Vincenzo Ferri. Virus infections Volatile fuels WWII wrecks War stories Washout treatments Wastewater Watchman device Water Resistance Water Weakness Weigang Xu Weights West Papua Western Cape Diving Wet Lenses Wet diving bell Wetsuit fitting Wetsuites Wetsuits White balance Whitetpped Sharks Wide Angle Photos Wide angles Wildlife park Wildlife Winter Wits Underwater Club Wolf Eels Woman and diving Woman in diving Womans health Woman Women In Diving SA Women and Diving Women in Freediving Women in diving Womens Month Womens health Work of Breathing Workout World Deeepst Dive Record World Records Wound dressings Wreck History Wreck divers Wreck dive Wreck diving Wreck exploration Wreckdiving Wrecks Yoga Youth diver Zandile Ndholvu Zanzibar Zoology Zooplankton \ Blennies abrasion absolute pressure acoustic neuroma excision adverse seas air-cushioned alert diver altitude alveolar walls anemia antibiotics anticoagulants antiseptics bandages barodontalgia bent-over barbell rows bioassays biodiversity bloodcells blue carbon body art breathing air calories burn canal blockage carbon dioxide toxicity cardiovascular career developments cerebrospinal fluid cervical spine checklist chemo port children child chronic obstructive pulmonary disease clearances closed circuit scuba compressed gass coral growth corrective lenses currents cuts cylinder filling dead lift decompression algorithms decongestants decongestion deep dive training dehydration discovery dive clubs dive injuries dive medicing dive ready child dive reflex dive tribe divecomputers diver in distress diver rescue diver training dive diving attraction diving hoods doctors dolphns domestic travel dri-suits drowning dry mucous membranes dry suits dry e-cigarettes ear spaces elearning electrolyte imbalance electroytes emergency action plans emergency assessment emergency training environmentally friendly equalising equalizing exposure injuries eyes fEMAL DIVERS fire rescue fish watching fitness Balance fitnes flexible tubing frediving freedivers gas bubble gas poisoning gastric acid gene expression health heartburn histidine hospital humidity hypobaric hypoxia immersion and bubble formation immersion pulmonary edema (IPE informal education isopropyl alcohol jaundice join DAN knee lanyard laparoscopic surgery life jackets longevity lower stress lox oxygen level lungs malaise mamalian effect marielife marine pathogens medical issues medical procedures medical risk assesment medications mental challenge mental preparedness micro-organisims micro minor illness mucous membranes multilineage dysplasia myelodysplasia nasal steroids nasal near drowning nematocysts neurological newdivers nitrogen bubbles no tanx off-gassed operating theatre operations orthopeadic otitis media out planting outgas pain parameters perforation phillippines phrenic nerve physical challenges pinched nerves plasters pneumoperitoneum polyester-TPU polyether-TPU post dive posture prescription mask preserve prevention professional emergency responders proper equalization psychoactive pulmonary barotrauma. pulmonary injury. pulmunary barotrauma pure oxygen radiation rebreather mask rebreathers retinal detachment risk areas safety stops saturation scissors scuba equipment scuba sea goddesses single use sinus infections situationalawarenes smoking snorkeling. spearfishing sterilising stings strength sub-aquatic sunscreen lotion swimmers ears tattoo care tecnical diver thermal protection tissue damage toxicity trachea training trimix unified standards upwelling virtual coach vision impaired vomiting warmers water quality zinc oxide