Skill Development Course
First Aid for Divers
Instructor Manual
First Aid for Divers Instructor Manual
Contents
Course Arrangements
1
Introduction
4
Principles and Priorities of First Aid
6
Summoning Assistance
11
Shock
14
First Aid Kits
17
Wounds and Bleeding
20
Burns
25
Injuries to Muscles, Bones and Joints 30
Other Conditions
36
Open Forum, Debrief and Disperse
48
Casualty Examination - practical
50
Bandaging - practical
52
Dressings, Splinting and Moving Casualties - practical
54
Appendix A: Incident Statistics
56
Appendix B: FAD Casualty Assessment Checklist
57
Issue 1.1, November 2009
Copyright © British Sub-Aqua Club 2009
Published in the United Kingdom
British Sub-Aqua Club, Telford’s Quay, South Pier Road, Ellesmere Port, Cheshire CH65 4FL
Telephone: 0151-350 6200 Fax: 0151-350 6215
www.bsac.com
All rights reserved. This Instructor Manual may not, in whole or part, be copied, photocopied, reproduced or
translated, or converted into any electronic or readable form without prior written consent of British Sub Aqua
Club
V1.1 Copyright © BSAC 2009
i
First Aid for Divers Instructor Manual
BSAC is grateful the members who contributioned to the development of this course and its supporting materials.
In particular:
Andy Botten
Andy Proctor
Anjali Shah
Martin Hammond
Richard Scarsbrook
Trevor Davies (original author)
Where illustrations have been sourced from the internet or from photographers who have requested attribution,
the acknowledgement and the licensing arrangement where applicable is shown on the Notes page of the first
Powerpoint slide of the relevant lesson.
ii
V1.1 Copyright © BSAC 2009
First Aid for Divers Instructor Manual
Course Arrangements
First Aid for Divers
Course Aim
The course aim is to teach the basics of first aid
likely to be needed in the BSAC diving environment,
making use of the resources likely to be available at
the time including improvisation of dressings and
splints using materials and equipment commonly
available at the dive site or in a boat. The course
focuses on the recognition and treatment of
conditions which are not covered in the BSAC Diver
Training Programme.
First Aid Kits
Wounds and
Bleeding
Bandaging practical
Course Overview
This manual contains the advice current at the time
of writing. Updates and new versions are published
on the BSAC website from time to time. Instructors
should always check there to ensure that they are
using the latest information.
This course teaches BSAC members basic first aid
relevant to the types of accident and illness that
may arise in the sport diving environment, many
of which are not specific to diving but just happen
when the individual is engaged in diving related
activities. Throughout the course instruction should
concentrate on the real-life situation, emphasising
the practical content with only sufficient explanatory
theory to put the practice into context.
Burns
Injuries to
Muscles, Bones
and Joints
The emphasis of this course is somewhat different
to those run by the major first aid organisations,
where first aid is taught for the non-diving situation
leaving divers themselves to resolve the application
of the techniques taught to diving situations.
The course contains explicit images of actual
injuries, which some people might find disturbing.
Session
Contents
Mins
Introductions
Introduction
and
domestic
15
arrangements
Principles and
Principles, role of
Priorities of First
first aider, multiple
30
Aid
casualties, hygiene
Casualty
Examination 40
practical
Getting help at
Summoning
sea, getting help
10
Assistance
on land
Causes,
signs
Shock
and
symptoms,
15
treatment
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Small boat kit,
dive manager’s kit,
supplementing the
kits, improvisation
Bleeding
and
clotting, types of
wound and causes,
general treatment
principles, internal
bleeding
Other Conditions
Dressings,
Splinting and
Moving Casualties
- practical.
15
20
60
Classification
of
burns, types of
burn and causes,
general treatment
principles,
electrical
burns,
chemical
burns,
knowing
when
hospital treatment
is needed
The
skeleton,
sprains
and
strains
causes
signs
symptoms
and
treatment,
fractures
and
dislocations causes
signs
symptoms
and
treatment,
practical issues
Signs symptoms
and treatment of:
minor barotrauma
- mask squeeze,
ears, sinuses, teeth;
l i fe - t h r e a te n i n g
conditions - severe
head injury, stroke,
heart
attack,
blast
injury;
miscellaneous
marine
animal
stings,
seasickness,
hypothermia,
hyper thermia,
exhaustion
15
20
30
90
1
Course Arrangements
First Aid for Divers Instructor Manual
Open Forum,
Debrief and
Disperse
published on bsac.com, along with a procedure
for applying for approval of training not on the
list.
20
Total
Lead instructors must also self certify that
they have demonstrated their knowledge of
the course content and competence in all the
skills taught, to the standards defined in this
Instructor Manual, to another BSAC Open Water
Instructor or above within the year preceding
the course. An Instructor Declaration form is
included with the course materials.
380
6h20
Duration
The above timetable represents the recommended
arrangement for a one day course.
If necessary the course may be run over a longer
period, such as a series of evening sessions,
provided that content, duration and order of the
lessons is not changed. In this case instructors
should check that their students do not lose
knowledge and skills between sessions.
Entry Level
Any BSAC member.
Experience on dive trips, and knowledge of diving
procedures and diving related physiology to at least
Ocean Diver level is advantageous.
Qualifications Awarded
Qualification card confirming course attendance,
supplied by BSAC HQ on payment of fees and
confirmation of attendance on the course. There
are no examinations or assessments.
First aid skills deteriorate rapidly if not used or
practiced regularly so it is recommended that
students undertake a refresher course at least
every three years.
First aid skills deteriorate rapidly if not used or
practiced regularly so the lead instructor should
verify that all the assisting instructors have an
appropriate knowledge of the course content
and an appropriate level of competence in the
skills being taught.
●
Student:Instructor ratio
The student:instructor ratio for practical training
should not exceed 12:1. There is no limit for
theory-only sessions.
Overall student numbers may also depend on
the available space and equipment for practical
sessions. During practical sessions students
will normally work in pairs.
Equipment
Each student requires:
• triangular bandage
• dressing
material)
(with
integral
bandaging
• diving gloves/hood
Course Registration
• weightbelt (weights are not required)
Branches wishing to run a Skill Development Course
must order the packs two weeks in advance from
the BSAC Shop and pay the relevant course pack/
registration fees for all students on the course.
This can be done online via the BSAC website, by
telephone, or by post.
• fins
Consult the BSAC website or HQ for current details
and associated declaration and report forms.
Instructor Requirements
● Qualifications
The lead instructor must be a BSAC Open Water
Instructor or above who has attended First Aid
for Divers, or has equivalent or more extensive
training approved by the Chief Instructor for
Rescue Skills. A list of approved training is
2
Two first aid kits are required for demonstration
purposes: one suitable for use in a small boat and
one for use in a large hard boat or as a shore based
dive manager’s kit.
A selection of items that commonly appear on a dive
site (such as oars, long-sleeved jackets, jumpers,
knife straps and sheaths, lifejackets, snorkels,
electrical insulating tape, survival blankets and
old rags of various sizes) is required for practical
sessions.The intention of the course is to teach
divers how to improvise to supplement what is
available in their first aid kit.
For the casualty examination lesson, a number of
small torches will be required.
Sufficient quantities of the above equipment will
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First Aid for Divers Instructor Manual
Course Arrangements
be needed to ensure that all pairs of students have
adequate resources during the practical sessions.
Students will need to kneel or lie on the floor at
times during the course, and should wear clothing
appropriate to the venue.
Venue Facilities
A suitable classroom with teaching aids for the
presentation of theory lessons.
Practical sessions require sufficient suitable space
for 'casualties' to lie on the floor while 'first aiders'
work on them.
Administration
HQ will supply the appropriate course packs and a
Course Report form, on receipt of an order. After the
course the organiser should return the completed
form together with a completed Instructor
Declaration form without delay to BSAC HQ, who
will issue qualification cards to students and
record their course attendance on the membership
database.
For regionally run courses: on completion of the
course, instructors should forward outstanding
fees, accounts and expense claims etc, to the
course organiser
Costs
BSAC course fees cover the cost of course packs
and certification cards, and are payable in advance
to register and purchase student packs.
For branch run courses, instructor expenses, venue
fees, and any other costs are the responsibility of
the students and their organisers.
For regionally run courses, students must pay
the appropriate regional course fee to the Skill
Development Course Organiser at time of booking.
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Theory Lessons
First Aid for Divers Instructor Manual
INTRODUCTION
Lesson Objectives
This lesson sets the scene for the course overall. It briefly outlines the course content,
domestic/logistics and timetable.
Achievement Targets
At the end of this lesson students should:
● understand the objectives and structure of the course.
● understand what is required of them during the course.
● understand the domestic and logistical arrangements for the course.
● understand the course timetable.
Introduction
Note for instructors: the comments in [square brackets] that occur throughout this
manual are there to help instructors deal with questions that might come up. They are
not part of the standard course material.
First Aid for Divers
Introductions
Introduce the instructors, and get the students to introduce themselves. Introductions
can be minimised or omitted on courses where the participants already know one
another.
Ask the students to describe accidents whilst diving that they have been involved in,
whether as casualty, helper or bystander, or ones they know of in their branch.
Course aims
● first aid for common injuries and illnesses
The aim of FAD is to instruct divers in the first aid actions to be taken when
dealing with injuries and illnesses which are likely to occur during club diving
activities.
[Appendix A contains data summarised from several annual incident reports,
illustrating relative frequency of various types of accident and injury.]
4
●
specific to club diving situations
The emphasis of the course is somewhat different to those run by the major
first aid organisations, where first aid is taught for the non-diving situation, thus
leaving the diver to resolve the application of the techniques taught to diving
situations. The First Aid for Divers course aims to avoid this by concentrating on
the real-life situation giving emphasis to practical content with only sufficient
explanatory theory to put the practice into context.
●
other BSAC safety training
Explain that this course focuses on injuries and techniques not covered elsewhere
in the suite of BSAC Rescue Skills SDCs (Practical Rescue Management Course,
Oxygen Administration, Automated External Defibrillator, and the Lifesaver
Awards) or in the Diver Training Programme. This is why basic life support, oxygen
administration, DCI and gas poisoning are absent from FAD: they are adequately
covered elsewhere.
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Theory Lessons
Use of oxygen
It is normal practice to carry emergency oxygen on dive trips, because it is such an
effective first aid treatment for DCI and similar conditions. Oxygen can also supplement
first aid measures for some of the injuries covered on this course. to increase their
effectiveness. Where this is the case it is mentioned in the text. If oxygen is not available
the other first aid measures are still appropriate.
Oxygen should only be administered by those who have been trained in its use.
Remind students that oxygen should not be given to non-divers. People with conditions
such as chronic lung diseases may suffer adversely, possibly to a fatal extent, by the
administration of oxygen. As these people would be precluded from diving, divers
should restrict themselves to administering oxygen only to other divers.
Domestic arrangements
Fire exits, catering facilities, house rules, etc.
Locations
Cover the different venues that will be used during the course, if necessary
Timings
Outline the timetable for the course, including breaks, lunch, and finish time. Either
issue a printed timetable, or add it to this VA.
Guideline durations for each session are provided in the Course Arrangements section
of these notes.
Course outline
Principles and priorities of first aid
Casualty examination – practical
Summoning assistance
First aid kits
Shock
Wounds and bleeding
Bandaging – practical
Burns
Miscellaneous injuries and conditions
Injuries to muscles, bones and joints
Dressings, splinting and moving casualties – practical
Open Forum, debrief and disperse
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Theory Lessons
First Aid for Divers Instructor Manual
PRINCIPLES AND PRIORITIES OF
FIRST AID
Lesson Objectives
This lesson explains the basic principles of first aid, and describes how first aid fits into
the overall process of rescue management. It also covers prioritisation when dealing
with multiple injuries and multiple casualties, and addresses hygiene issues for both
casualties and first aiders.
Achievement Targets
At the end of this lesson students should:
● be able to list the priorities of first aid
● understand the role and responsibilities of the first aider
● know what to do if there are multiple casualties
● be able to prioritise hygiene appropriately
Principles and Priorities of First Aid
Principles of first aid
This VA serves as the introduction for the lesson. Subsequent VAs cover the implications
of these basic principles on what a first aider does and doesn't do.
Definition
● accepted principles of treatment
● any injury or sudden illness
● available facilities or materials
Priorities
Extracting as much information as possible from the students, explain each of the
priorities of first aid:
●
●
●
preserve life
prevent deterioration
promote recovery
Do the MINIMUM necessary
Stress that the object is to do the MINIMUM necessary to accomplish the above.
Well intentioned attempts to do more may complicate the subsequent treatment
administered by medical personnel.
Role of a first aider
Define the role and responsibilities of the first aider:
Assess the situation
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Theory Lessons
Assess what is wrong
History, signs and symptoms. Signs are visible to the first aider eg, swelling,
discolouration, vomiting, casualty's response to stimuli. Symptoms are reported by the
casualty and cannot be directly observed by the first aider eg, nausea, level of pain,
dizziness.
Give appropriately prioritised treatment
Give immediate and appropriate treatment
Arrange for removal to medical aid
Covered in the next lesson
Remain with the casualty
● Until recovered
● Or evacuated
Responsibility ends when
● Handed over to medical personnel
● Report given
Assess the situation
Rescue Management is covered in depth in the BSAC Diver Training Programme Dive
Leader course, and in the Skill Development Course Practical Rescue Management.
Be calm and take charge
Many diving incidents involve some form rescue in order to get the casualty from the
water to a place of safety where first aid treatment can be given. This course does not
teach the skills required for the management of diving rescues, but first aiders need
to be aware that even when the casualty is on dry land or on a boat hazards may exist
which need to be managed.
Ensure safety
● yourself
● casualty
People with conditions such as chronic lung diseases may suffer adversely,
possibly to a fatal extent, by the administration of oxygen. As these people would be
precluded from diving, divers should restrict themselves to administering oxygen
only to other divers.
●
bystanders
Guard against further casualties
Reassure the casualty
Get others to help
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Theory Lessons
First Aid for Divers Instructor Manual
Casualty assessment
A prompt and accurate evaluation of the casualty's injuries, sufficient to allow the
correct first aid treatment to be rapidly applied, could be the difference between life
and death. Exact diagnosis is left to the doctors, once the casualty has reached them.
This course deals mainly with the evaluation of non-diving conditions. In the practical
session which follows, students will use the FAD Casualty Assessment Checklist which
helps carry out assessment in a systematic and organised way.
[Casualty evaluation for a diving incident is covered in lesson DT4 of the BSAC Dive Leader
course, and in the Oxygen Administration Award, where the appropriate conditions are
addressed. The Casualty Assessment form which supports the evaluation of diving
incidents is not suitable for FAD because it covers a different range of conditions.]
Incident history
A knowledge of what happened can help diagnosis. For example, it may suggest which
types of injury are likely and which are unlikely.
Signs
Signs are features of the casualty's condition which can be observed by the first aider,
such as bleeding, swelling, vomiting, pulse and responsiveness.
Symptoms
Symptoms are features which are reported by the casualty but cannot be observed by
the first aider, such as feeling sick and headache.
Preserve life
Explain the practical impact of the priorities of first aid on the treatment administered:
Basic Life Support
● Airway
● Breathing
● Circulation
[now sometimes stated as ‘Compressions’. Some authorities feel that arguments
about which is ‘correct’ are rather PC].
Control bleeding
Prevent deterioration
Limit the effects
● treat shock
● dress wounds
● immobilise large wounds and fracture
● comfortable position
Promote recovery
Reassure the casualty
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Theory Lessons
Relieve pain
Handle gently
Keep warm
Arrange for evacuation
Multiple casualties
Extend the prioritisation to cover the situation where there are multiple casualties. If
there are insufficient resources to treat all casualties at once the most critical must be
dealt with first with the others treated as and when circumstances allow. Caution that
the noisiest casualties are rarely the most severely injured.
Priorities
● non-breathing
○ airway
○ resuscitation
●
unconscious breathing
○ recovery position
●
severe bleeding
Identify and treat most serious condition first
Treat others as circumstances allow
Noisiest casualty rarely most severely injured
Hygiene – casualties
In a life threatening situation saving a life remains the priority but in less critical
situations relatively minor problems could be aggravated by infection.
Major injuries
● saving life is priority
● worry about infections later
Minor injuries
● cleanliness essential
● prevent minor problem being aggravated by infection
Hygiene - first aider
Body fluids have potential to be infectious
Body secretions have the potential to be infectious (eg saliva, blood) but the likelihood
depends not only on the particular secretion (eg saliva least likely, then blood, urine,
faeces) but also on the casualty’s condition.
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Theory Lessons
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Keep risk in proportion
For the rescuer the main considerations are hepatitis B and HIV. Fears about contracting
these should not be allowed to get out of proportion.
Protection
● infections need entry point
Being splashed with infected blood alone will not cause infection. Infected blood
needs a means of entry for the rescuer to be infected (eg, an open cut).
●
intact skin
whole skin is an effective barrier
●
disposable gloves
In a controlled situation appropriate measures can be taken (eg, wearing surgical
gloves from a first aid kit) but where this is not possible their lack should not be
allowed to impact the first aid administered.
Afterwards
● wash off body fluids with soap/water
● clean spilt body fluids with bleach
● post event checks available
Post event checks for exposure are available if there is any doubt at all, with
appropriate treatment to counter Hepatitis B (gamma globulin) and to greatly
reduce the probability of infection from HIV.
Summary
Preserve life
Prevent deterioration
Promote recovery
Minimum necessary
First aid tasks
● assess the situation
● assess what is wrong
● give appropriate prioritised treatment
● evacuate the casualty to medical attention
Multiple casualties
Hygiene
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Theory Lessons
SUMMONING ASSISTANCE
Lesson Objectives
This lesson covers the procedures for summoning assistance at the coast and inland
for both diving specific and 'non-diving' accidents.
[Summoning assistance is covered in the BSAC Diver Training Programme in lesson
DT9.]
Achievement Targets
At the end of this lesson students should:
● know how to summon assistance for injuries and illnesses at sea
● know how to summon assistance for injuries and illnesses on land
Summoning Assistance
Contrast the greater familiarity with diving incidents that the emergency services
around the coast have when compared to those inland, and the implications of this.
Summoning assistance
Who you should call for assistance depends on the location and the nature of the
problem. This VA summarises what to do, and the following VAs give details of how to
make contact.
At sea
● coastguard for all types of emergency
On land
● DCI – BHA/RN Diver Helplines
The contact for advice on treating suspected DCI casualties (not covered on
this course). [Rarely the casualty may have suspected DCI and an injury whose
recommended treatment conflicts with the recommended treatment for DCI (egs
heart attack + DCI - aspirin or no aspirin? Suspected internal bleed/heavy bleeding
from legs/shock + DCI - elevate legs or legs flat?). There is no correct answer for all
circumstances. Contact the Diver Helpline for advice.]
●
●
●
lost diver – police
injuries – ambulance
write down incident details
○ incident history
○ signs & symptoms
○ first aid given
○ give to ambulance crew
○ send with casualty
If the casualty is evacuated by other means eg, lifeboat, helicopter, you
should still send written details.
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First Aid for Divers Instructor Manual
Emergency services at sea
All contact, including that with the BHA/RN Diver Helplines will be via the Coastguard,
which is contacted by VHF radio on channel 16.
● Where life is in danger, or a vessel is in grave and imminent danger, the call
should be prefixed by the words MAYDAY, MAYDAY, MAYDAY. [The call should be
preceded by a distress alert using a DSC-equipped radio, if available – this is
the method most likely to ensure the distress call is heard].
● Where medical aid is required the call should be prefixed by the words PANPAN, PAN-PAN, PAN-PAN
● Where a provocative event has occurred and no symptoms are displayed, then
a routine call for medical advice may suffice
The call should contain information regarding the vessel’s identity, its position and
intentions, the nature of the emergency and what assistance is required. Any instructions
from the emergency services must be communicated back to the rescue manager.
[Note: For courses run outside the UK, instructors should substitute the corresponding
local information.]
Contact coastguard on VHF DSC and/or channel 16
● Mayday = life in imminent danger
● Pan Pan = assistance urgently required
Give full details
○ vessel’s name/call sign
○ position and intentions
○ nature of emergency
○ assistance required
Report back to rescue manager essential
Emergency services on land
For many incidents (such as lost divers or near drowning) the Police and/or Ambulance
Services will be required. Around the coast some incidents may require the assistance
of the Coastguard. All are contacted by the normal 999 or 112 telephone call. Where
decompression illness or burst lung are suspected, however, the British Hyperbaric
Association/Royal Navy (BHA/RN) Diver Helplines should be contacted. The reason
for the different number in Scotland is because, unlike the rest of the UK that comes
under one Health Service, Scotland has its own.
On initial contact, details of the nature of the incident, its location and the numbers
of casualties involved should be given. Again, a report back to the Rescue Manager is
essential.
[Note: For courses run outside the UK, instructors should substitute the corresponding
local information.]
Police/Ambulance/Coastguard
● Telephone: 999 or 112
British Hyperbaric Association / Royal Navy Diver Help Line
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Theory Lessons
Make sure these numbers are in your mobile!
[If appropriate get the students to store the numbers in their mobiles immediately, or
at the first break.]
●
●
England, Wales & N. Ireland: 07831151523
Scotland: 08454086008
Give full details
● nature of incident
● location
● personnel involved
Report back to rescue manager essential
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Theory Lessons
First Aid for Divers Instructor Manual
SHOCK
Lesson Objectives
Shock is present to a greater or lesser degree in all injuries and is referred to frequently
in other lessons. The main purpose of this lesson is to ensure that the students clearly
understand what shock is, how it occurs, its recognition and, although it cannot be
treated directly, what to do about it.
[Shock is covered in the BSAC Diver Training Programme in lessons DT3 and AT4]
Achievement Targets
At the end of this lesson students should:
● understand the definition of shock
● know the causes of shock
● be able to list the signs and symptoms of shock
● be able to list the actions to be taken for casualties in shock
Shock
Shock
Circulatory shock is a life-threatening medical condition. It is not the same as the
emotional 'shock' which can occur in reaction to a frightening or distressing event,
such as witnessing an accident.
Inadequate circulation
Shock occurs when an injury or illness causes a drop in the flow of blood through the
body.
●
tissue damage due to inadequate oxygenation and waste removal
Since the blood delivers oxygen and nutrients to the tissues, and carries away
waste products, shock causes tissue damage. Initially the body responds by trying
to maintain the circulation: the heart beats faster, the blood vessels constrict,
and the kidneys retain fluid in the circulation. In serious cases the body's
responses may not be enough and a downwards spiral can set in where, for
example, insufficient oxygenated blood reaches the heart causing a further fall in
output, and so on.
●
life-threatening
Eventually cells in organs and tissues throughout the body may begin to die,
producing further waste products and damaging the body's ability to function
even more, leading ultimately to the patient's death.
Consider in all major injuries
Shock should be considered in most injuries, but does not occur in minor injuries
(except for emotional shock, which is a different condition).
Causes
● reduced blood volume (bleeding, burns, bruising, prolonged seasickness)
aka hypovolaemic shock.
Anything that leads to excessive loss of fluid from the circulation can lead to
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Theory Lessons
hypovolaemic shock. The lost fluid may still be retained within the body eg,
internal bleeding, and oedema (blisters, swelling).
●
massive dilation of blood vessels (fainting, hyperthermia)
aka low resistance shock, neurogenic shock. May result from head/spinal injury.
●
inadequate cardiac output (heart attack, pulmonary barotrauma)
aka cardiogenic shock
Pulmonary barotrauma may involve pneumothorax, which can put pressure on
the heart, reducing its output. Pneumothorax can also result from other, nondiving injuries.
●
allergic reaction to drugs, food or stings
aka anaphylactic shock
●
removal from the water after prolonged immersion
aka immersion shock
Dealing with shock
Signs & symptoms
● weakness, dizziness
● pallor, sweating
● rapid pulse and breathing
● breathlessness, unconsciousness
Treatment
● contact the emergency services
● reassure, keep casualty quiet
● lay casualty down, legs raised (but not for DCI or burst lung)
● keep warm and comfortable
● administer oxygen
● monitor condition
● give nil by mouth (except for DCI)
● treat prime cause
Immersion shock
If a casualty has spent a long period immersed in the water, (for example lost divers)
the muscle tone relaxes, including those in the walls of the blood vessels, due to the
support from the water countering the effects of gravity. If removed from the water in
an upright position, gravity causes the casualty's blood to descend towards the lower
limbs, which the relaxed muscle tone is unable to counter. The result is that the vital
organs are starved of a blood supply.
First aid
● keep casualty in horizontal attitude at all times
● discourage any movement or activity by the casualty
● other actions as for shock
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Theory Lessons
First Aid for Divers Instructor Manual
Summary
Caused by inadequate circulation
Life-threatening condition
Expect in all major injury cases
Treat prime cause
Legs raised, O2, TLC, no fluids, evacuate
Special cases
● immersion shock
● DCI
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Theory Lessons
FIRST AID KITS
Lesson Objectives
This lesson considers the contents of first aid kits, for dive expeditions and for boats. It
also introduces the idea of improvising when a first aid kit is limited or not available, by
using materials that should be available in diving situations as alternatives.
Achievement Targets
At the end of this lesson students should:
● know the recommended contents of first aid kits
● have considered practical alternatives to conventional first aid materials using
items commonly found in the diving environment
Additional visual aids
Small boat and large boat/dive manager's first aid kits for demonstration. The
demonstration kits should include waterproof cases, and examples of individually
wrapped contents.
First Aid Kits
Cover the typical contents of a small boat kit and an offshore/dive manager's kit
using the demonstration kits. Highlight the particular considerations for the 'wet'
environment and the necessity for each item to be individually wrapped and stored in a
waterproof container. Include a reminder that no kit will cover all eventualities and that
improvisation should not be forgotten.
First aid kits should be replenished as soon as practicable after use so that they remain
at full capacity at all times.
First aid kits
Tailor to expected circumstances
● small boat kit
● dive manager’s/hardboat kit
● others eg tropical, expedition
Waterproof container
The whole kit should be housed in a waterproof container.
Supplement by improvisation
Supplement the kit by improvisation using boat equipment. Cover this in more detail
after looking at the contents of first aid kits in detail.
Small boat kit
The following is the minimum contents of a first aid kit for inshore (up to 3 miles) use, as
recommended in the Combined Diving Associations Guidelines for the Safe Operation
of Member Club Dive Boats (CDA Guidelines). [The guidelines refer to ‘large’, ‘medium’,
etc, sizes. As is common in first aid guidelines even from well known organisations,
these terms are not defined. The reality is that there is no standard. It is possible to
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buy a selection of dressings from different manufacturers all labelled ‘large’ and all
different sizes. ‘Large’ is bigger than ‘medium’ but smaller than ‘extra large’.]
2 x Large sterile dressings
1 x Large pack of assorted adhesive dressings
2 x Large triangular bandages
If the triangular bandages are bought and kept as sterile items, they will double as
large wound dressings
1 x Rescue blanket or large polythene bag
6 x Safety pins
You can use adhesive tape instead if necessary: some organisations have banned
safety pins from first aid kits on health and safety grounds!
Disposable gloves
Items individually wrapped in sealed plastic bag
This prevents unused items getting contaminated when the main container is
opened.
Dive manager's kit
The following is the minimum contents of a first aid kit for offshore (over 3 miles) use,
as recommended in the CDA Guidelines.
Offshore kit (in excess of 3 miles):
1 x First aid instructions
6 x Each small, medium and large standard dressings
1 x Large pack of assorted adhesive dressings
4 x Large triangular bandages
10 x Assorted safety pins
3 x 50mm roller bandages
1 x 50mm crepe bandage
1 x Roll 25mm zinc oxide plaster
1 x Set of scissors
1 x Set of tweezers
1 x Pack of sterile cotton wool
2 x Pairs of disposable gloves
1 x Rescue blanket or large polythene bag
1 x Pocket mask, or suitable barrier, for use when giving AV
As for a small boat kit Items should be individually wrapped and sealed in plastic bags,
and the whole kit should be housed in a sturdy weatherproof container. The kit can be
supplemented by improvisation using boat equipment and other materials to hand.
Additional items may be necessary if the diving is to take place in remote locations
where medical resources are not readily available and/or the expedition is of a long
duration. When going abroad for a typical commercially-organised group holiday, if
every member of the trip takes an individual selection of items, that means that the
group will have a good selection of items, in quantities to deal with anything. Finally,
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get the students to think how they could use common dive-related items as a
substitute for conventional first aid materials. Explain that improvisation will be
a theme running through the practical lessons on the course.
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WOUNDS AND BLEEDING
Lesson Objectives
The lesson outlines the basic mechanism of blood clotting and explains the consequent
need to keep the casualty still to prevent break-up of clot formations. It covers the major
types of wound, giving examples of how each may occur in diving related activities, and
describes the different ways of controlling bleeding, explaining how each works and
when each would be used.
Achievement Targets
At the end of this lesson students should:
● know the major types of wound and their potential causes
● understand the general first aid measures to be used for bleeding
● understand the measures to be taken for internal bleeding
Wounds and Bleeding
Contents
Types of wound
Bleeding and clotting
Treatment
Wounds
●
Any damage to the skin or underlying tissues
Wounds come in all shapes and sizes, and may stem from a wide range of
causes. The wounds that divers have to deal with are most likely to be acute
injuries resulting from an accident.
●
Open wound
Open wounds are usually easy to spot, and the consequences are obvious.
○ skin is breached
○ blood lost from the body
○ allows infection into the body
Very large wounds may allow internal organs, such as intestines, to spill out of the
body.
●
Closed wound
It is important to realise that closed wounds are common, and that their
consequences can be just as life-threatening as those of open wounds.
○ underlying tissues damaged beneath intact skin
○ blood lost from circulation but NOT from the body
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Types of wound
Open
● incision
These are slicing wounds made by something sharp like a knife, a piece of
broken glass, or a rusted piece of wreckage. An incision usually has clear edges
which fit together well if held together. An incision may be as trivial as a paper
cut, or a significant injury which cuts through major blood vessels and organs.
●
laceration
A laceration is a wound that is produced by the tearing of soft body tissue.
Lacerations can result from impacts with blunt objects, contact with machinery,
or crushing. This type of wound is often irregular and jagged. A laceration is
often contaminated with bacteria and debris from whatever object caused it.
Typical causes during diving include falling heavily onto objects such as a bollard,
having heavy objects such as cylinders fall on you, crewing injuries in heavy
weather at sea, and propeller injuries.
●
abrasion
Abrasions, if minor, are also called scrapes or grazes. They occur when the skin
is rubbed away by friction against a rough surface egs, chafing from the tubes of
a RIB when clinging on in rough weather, rope burns, and skinned knees from
falls. An abrasion usually appears as lines of scraped skin with tiny spots of
bleeding, but more serious abrasions can remove tissue to a substantial depth.
Divers may receive abrasions if they have to exit the water over rocks in a rough
sea, especially if they are not wearing gloves. Divers who hire motorcycles or
quad bikes while waiting for a late flight on the last day of their warm water
liveaboard trip risk serious abrasions if they fall off without proper protective
clothing!
●
puncture
Puncture wounds are deep, narrow wounds caused by sharp objects such as
knives, nails, broken glass. There may be little bleeding around the outside of the
wound. Punctures may have pieces of debris broken off in side, and are prone to
infection.
In a diving setting, puncture wounds often result from marine animal bites,
or from being impaled by fish or urchin spines, possibly venomous such as a
stonefish. They may also arise from stepping on sharp objects, and from getting
impaled with fish hooks. Serious puncture wounds can be caused by being
impaled on a sharp object such as railings, or underwater, being driven onto
spikes of wreckage by wave action.
●
'gunshot'
A 'gunshot' wound is caused by an object entering the body at a high velocity.
If the missile releases much of its kinetic energy inside the body there may be
massive damage. The entry wound may also be accompanied by an exit wound,
and either or both can vary from a small hole to a large ragged injury.
Gunshot wounds might occur if a diver was hit by flying debris after a cylinder
explosion.
Closed
● contusion
Contusions are the result of a heavy impact that causes an internal injury without
breaking the skin. Contusions show up as bruising. The types of accident that
lead to contusions in diving situations are similar to those that cause lacerations.
●
internal bleeding
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Internal bleeding may occur without any outward sign; it may only show up on
X-rays or other medical images. Internal bleeding is likely following deep puncture
wounds, and after impacts involving rapid deceleration of the body, such as high
speed accidents.
Bleeding and clotting
Ruptured blood vessels
When blood vessels, whatever their size, are cut or punctured in an accident, blood
cells escape through the hole. This is bleeding. The damaged cells in the blood vessel
release messenger chemicals into the bloodstream.
●
●
blood cells escape
wounded tissue releases chemicals
Platelets
The messenger chemicals are detected by small specialised blood cells called platelets.
They begin to stick to the walls of the damaged blood vessel in the vicinity of the
wound. They also release other messenger chemicals which active further processes
in the chain. One messenger causes the injured blood vessels to constrict, reducing
the blood loss. Other messengers cause a sequence of events which results in the
formation of long sticky threads of a substance called fibrin.
●
●
●
●
stick to edges of wound
release further chemicals
blood vessels contract
fibrin threads form
Blood clot
The fibrin threads form a mesh-like net over the hole in the blood vessel, trapping blood
cells and preventing them from leaking out. Eventually this structure coagulates and
hardens forming a clot, which on a surface wound will eventually appear as a scab.
Once clotting has occurred, further healing processes begin within hours, but this
is normally well after the first aider has handed the casualty over to the medical
services.
●
●
fibrin threads form mesh over wound, trapping blood cells
clot hardens, sealing hole
Keep casualty still to help clotting
The crucial points for the first aider to remember are that the vital process of clotting
takes time, and that in its early stages the clots are delicate, which means that the
affected parts of the casualty's body must be kept still to allow healing to occur.
[Further healing processes begin within hours of injury, but these are beyond the scope
of first aid, normally occurring well after the first aider's job is done.]
Treatment principles
Treatment of wounds involves stopping any bleeding, then cleaning and dressing the
wound to prevent infection. Additional medical attention may be required if the effects
of the wound have compromised the body's ability to function effectively.
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Minimise blood loss
Help body cope with blood loss
Prevent infection
Treat for shock
Minor open wounds
Treatment
● clean wound
● dry wound
● apply sterile dressing
● apply firm bandage
Severe bleeding
Severe bleeding is immediately life-threatening, so controlling the bleeding is the top
priority, and infection control is left for the medical professionals to deal with later..
Treatment
● apply pressure
● raise & support injury
● apply sterile dressing
● if more required apply further dressings on top
● bandage firmly
● DO NOT use tourniquets or pressure points
[Pressure Points: some agencies still teach the use of pressure points for indirect
control of severe bleeding. Also the current edition (September 1998) of Safety
and Rescue Skills for Divers recommends it. If asked, provide the following
explanation of why BSAC recommends against its use: the technique is only
effective if practised, and the skill is unlikely to be retained for long without
practice. BSAC thinks it is counter-productive to teach a method which is likely to
fail when attempted, especially when it would be used in situations where every
second counts.]
●
immobilise affected area to help blood clotting
Severed body part
Wrap any severed body part, such as a finger, in a plastic bag, cling film, or soft material,
and keep it cool. Ideally, place the severed body part in ice, but do not put it in direct
contact with the ice.
Make sure it travels to hospital with the casualty. If possible, label the bag, especially
if there is more than one casualty who has suffered an amputation.
●
●
●
bag it
keep cool and dry
send with casualty
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Internal bleeding signs & symptoms
Pain / tenderness
Bruising
Blood in spittle / urine
Shock without obvious blood loss
● weakness, dizziness
● pallor, sweating
● rapid pulse and breathing
● breathlessness, unconsciousness
Internal bleeding treatment
Lie down (legs raised)
Arrange evacuation
Record
● breathing
● pulse
● response levels
● treatment
Recovery position if casualty loses consciousness
Summary
Open wounds
Closed wounds
Clotting
Hygiene
Pressure
No tourniqets or pressure points
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Theory Lessons
BURNS
Lesson Objectives
The lesson explains the classification by depth and area, "rule of nines", and the general
principles of treatment (remove heat, treat shock, prevent infection) highlighting
any considerations peculiar to any of the types of burn (eg preventing chemical
contamination from being spread to unaffected areas).
Achievement Targets
At the end of this lesson students should be able to:
● assess a burn in terms of cause, extent, location and depth of the burn.
● provide appropriate treatment to a casualty with a burn
● recognise when a casualty with a burn needs to be taken to hospital for
treatment
Burns
Contents
Classification
The severity of a burn depends on its area, its depth, and to a certain extent, on what
caused it. The first aider needs to be able assess these things in order to decide
whether or not to call for medical evacuation, and to be able to explain the injury to
medical personnel by telephone or radio if necessary: whilst at sea, for example.
Signs and symptoms
Treatment
Types and causes
Concentrate on the sort of burns that divers are most likely to come across - dry burns
(eg, friction burns from ropes; from hot engines), scalds from hot water, chemical
burns from cleaning non-ferrous, sunburn on tropical holidays.
Dry burns
● flame
Fires, clothes on fire. Extinguish burning clothing as soon as possible. In a diving
situation it may be possible to jump in the water, provided it does not endanger
the casualty. Otherwise, smother the flames with a blanket or coat.
●
hot surface
Exhausts, cookers, pots and pans. High temperature surfaces can cause burns
very quickly: fortunately often casualties can move the affected part away as
soon as they feel the pain.
●
friction
Ropes.
●
electricity
Faulty wiring. Home-made shore power set ups on boats. Do not touch the
casualty directly unless the current is turned off. Move them with a non-
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conducting object such as a wooden stick if necessary.
●
radiation
Sunburn. Burning takes place relatively slowly. Varies with time of day. Burning in
the tropics, and in places where there is a hole in the ozone layer can be several
times faster than in the UK.
Scalds
● hot liquid
Cooking spillages, engine cooling water, hot oil. Soaked clothing will continue the
burning until removed or cooled.
Chemical
Cleaning fluids for non-ferrous metal.
Area
Bigger area = more severe
Burn area is expressed as a percentage of the patient's total skin area. The following
are techniques for estimating it.
Palm of casualty’s hand = 1%
Note that it is the casualty's hand not the first aider's hand that is used.
Wallace’s rule of 9s
● head
● arm
● chest
● upper back
● abdomen
● lower back
● thigh
● lower leg
[These figures are for normal adults. There are different versions for children, and for
the obese. However, the Rule of 9's is close enough for first aid purposes. The rule of
9s adds up to 99%: the missing 1% represents the genitals (it really does).]
Burn depth, signs & symptoms
The skin is the body's largest organ. The diagram shows a cross-section through it. The
thickness of the skin varies from person to person, and at different places on the body,
but typically it is only about 2mm thick. It consists of three different layers, for which
simplified descriptions are given below. The red area at the bottom of the diagram
represents the tissues which lie beneath the skin.
Skin structure
● epidermis - waterproof
The thin outer layer of the skin does not contain blood vessels or lymph ducts.
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It is a waterproof barrier which prevents fluids from leaking out of the body, and
prevents infections and other harmful agents from getting in. Sweat is able to
pass through via pores.
●
dermis - blood vessels, nerves, muscles
The dermis contains blood vessels, muscles (erector muscles for skin hairs),
nerve endings, and many other components.
●
subcutaneous tissue
Subcutaneous tissue is a fatty layer which lies above the body's internal tissues.
The thickness of this layer varies markedly between different parts of the body
(eg, feet, buttocks), and between different people (eg, Sumo wrestlers, v 'size 0'
fashion models).
Burn classification
● superficial
aka 1st degree burns
○ red/swollen/painful
●
partial thickness
aka 2nd degree burns
○ red/swollen/painful
May have a weeping, wet appearance
○ exposed to infection
Protection from the epidermis is lost
○ blisters
Fluids can leak out and form blisters.
●
full thickness
aka 3rd degree burns
○ pale/waxy/possibly charred
Waxy white burns may be mistaken for unburnt skin. Generally dry
appearance, and numb.
○ serious
The dermis and epidermis have been destroyed, and will not re-grow
without grafting. Tissues beneath the skin may also have been damaged
(sometimes referred to as 4th degree burns, as in the photograph).
○ Blisters
Electrical burns
Effects vary depending on a variety of items including the voltage, which parts of the
body are involved, how damp the victim is, and the length of time the current flows.
Possible features
● superficial surface injury
● extensive damage to lower layers
Current may enter the body at one point and exit at another, causing damage all
along the path, which may be internal.
●
cardiac arrest possible
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electric shock risk for first aider
Ensure that the current is switched off before you touch the casualty. Alternatively
push or pull the casualty away from the electrical source with a non-conducting
object such as a dry branch or a broom handle.
Treatment – superficial burns
Reassure casualty
Cool affected area
● gently flowing cold water
● up to 20 minutes
Cool for at least 10 minutes. Do not use ice water: "Cool the burn, warm the
patient".
Remove constrictions
Swelling may develop as fluid loss occurs. Remove items such as rings and bracelets
before they begin to cause discomfort or worse. Do not attempt to remove items that
show signs of adhering to skin.
Cover
If possible use strips of clingfilm, laid the length of the limb rather than wrapped around
it.
DO NOT
● break blisters
● apply lotions, ointments etc
● use adhesive dressings
Partial/full thickness
Lay casualty down
Cool affected area
Remove constrictions and wet clothing
Cover badly burned limbs
Immobilise if other injuries require it.
Treat for shock (and give O2)
● conscious – give sips of water
● unconscious – recovery position
Evacuate to medical attention
DO NOT
● break blisters
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●
●
●
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apply lotions, ointments etc
use adhesive dressings
remove dry clothing
Chemical burns
Follow instructions on container label ,if available, and give to ambulance crew
Flood with water
Rinse soda lime/caustic soda (used in rebreathers) with saline not water.
●
●
20 minutes minimum
keep water away from healthy tissue
Remove contaminated clothing
● gently
● avoid self/area contamination
● protection
Use protective gloves etc, as necessary.
Continue as for partial and full thickness burns
Do not give liqids if chemical has been ingested, unless chemicals label OKs it.
Evacuate to medical attention
Hospital treatment if burn is.......
Full thickness
To face, hands, feet, genitals
Right around a limb
Partial thickness > 1%
Superficial > 5%
Mixed pattern of thickness
Chemical
Summary
Classification
Signs & symptoms
First aid
Needing hospital treatment
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iNJURIES TO MUSCLES, BONES AND
JOINTS
Lesson Objectives
The lesson gives a description of the functions of the skeleton then briefly explains
what sprains and strains are, and their treatment. It covers the cause, recognition and
treatment of fractures and dislocation. To link to the later practical lesson, advice on
the practicalities of administering first aid for these types of injury is included.
Achievement Targets
At the end of this lesson students should:
● have an appreciation of the function of the skeleton and its attachments
● know the signs and symptoms of a sprain or strain and the appropriate treatment
● know the signs and symptoms of a fracture or dislocation and the general rules
for treatment
Injuries to Muscles, Bones and Joints
Contents
Anatomy
Sprains and strains
Fractures and dislocations
Bones and muscles
Knowing a little about how the body is constructed, and the different types of tissue
involved, helps the first aider understand the significance and implications of different
types of injury.
Skeleton
The skeleton is the bony framework of the body, which supports and protects the soft
tissues and organs.
30
●
bones
There are over 200 bones in the adult human body. They are connected together
at joints. The most common type of joint is called a synovial joint, where the
bearing surfaces of each bone are lined with cartilage, and are separated by a
lubricating fluid contained within the synovial capsule.
A broken bone is called a fracture, and normally requires first aid. The bones in a
joint can also be pulled out of alignment. This is called a dislocation, and requires
first aid.
●
ligaments
Ligaments are strong bands of slightly elastic tissue which hold the bones in
a joint together. They can be stretched, torn, or ruptured. When a ligament is
damaged, the joint can become unstable. Ligament damage can occur with or
without dislocation of the associated joint. First aid is required.
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Theory Lessons
support, protection, movement
The skeleton supports the soft tissues, and protects vital organs such as the
brain, spinal cord, heart, and lungs. The bones and joints form the levers and
pivots necessary for movement.
Muscles
● muscle
Muscle is a type of tissue which contracts strongly when triggered by nerves.
Skeletal muscle fibres are grouped into bundles which are contained within
a sheath making up a named muscle. The diagram illustrates the biceps
(contracted, wide) and triceps (extended, narrow) muscles in the upper arm.
When the biceps contracts the lower arm is drawn upwards at 90 degrees to
the upper arm, as shown in the diagram. If the biceps relaxes and the triceps
contracts, the arm will return to the position where the upper and lower arms are
in line.
Muscles can be strained or torn, requiring first aid.
●
tendons
Tendons are inelastic cords of tissue which attach muscles to the bones on
which they operate.
Tendons can be damaged, or ruptured.
●
movement, vital functions
Muscles enable us to move our bodies. Generally body movements are voluntary:
they take place as a result of conscious thought. Muscles also perform a variety
of vital functions which occur automatically, such as the heart pumping, and
digestive processes.
Sprains & strains
A strain is an injury to a muscle or tendon, and a sprain is an injury to the tissues
around a joint. These injuries usually occur after a singe event, such as a twisted
ankle, but they may also be caused by a series of lesser event events in which case
the injury may not become apparent until several hours later. The signs and symptoms
are described below.
Sprain
Sprains are caused when a joint is moved beyond its normal range, such as twisting
an ankle or wrenching a knee. In diving, ankle injuries can easily occur when walking
fully-kitted over uneven ground, because the boots on most suits make accurate foot
placement difficult, and also give little or no ankle support. Sprains are also likely as
a result of falls, particularly if kitted or carrying equipment because the fall will be
heavier and more awkward.
●
●
●
●
●
●
stretching or tearing tissues at a joint
pain at joint
swelling
bruising and discolouration (later)
pain on movement
inability to move joint
Strain
Strains usually occur as a result of strenuous activity. An example in diving might be
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lifting heavy cylinders and dive bags.
[The photograph on the VA shows a casualty with a torn hamstring, with the bruising
illustrating the internal bleeding which can occur. The bruising might not become
apparent until some time after the injury.]
●
●
●
overstretching of a muscle
sudden sharp pain at site of injury
swelling in limb muscle
Treatment
Treatment follows the acronym RICE - Rest, Ice, Compression, Elevation.
Rest - support in most comfortable position
Rest prevents further injury, and relieves pain. Braces or splints can be used to give
support when the casualty needs to continue using the injured area.
Ice bag or cold water compress
If applied soon after the injury, ice can prevent much of the swelling that would
otherwise occur. Apply ice for about 20 minutes at a time.
Compression with cotton wool and bandage
A compression bandage provides some support, and may help reduce swelling. However
it may also cause discomfort if it becomes too tight.
Elevation of injured area
Keeping the injured area as high as possible above the heart helps the body reabsorb
fluid that is causing swelling.
Evacuate to medical aid
Minor sprains and strains will heal of their own accord, but ruptured tendons and
ligaments may require surgical repair. If this is not performed immediately the results
may not be as good, and the casualty may be left with a permanent disability.
Fracture causes
Explain what a fracture is and give an explanation of how damage can be caused by
both direct and indirect force. The VA illustrates a fracture of the upper arm [humerus]
being caused by direct force, and a broken collar bone [clavicle] caused by indirect
force
Break or crack in bone
Direct force
Indirect force
Violent muscular contraction
One source of such contractions is an electric shock.
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Fracture features
Types
Explain the two types of fracture.
●
●
open
closed
The X-ray picture shows a fractured clavicle.
Complications
● associated injuries
Parts of the body adjacent to the fracture may have been damaged during
the incident, by broken pieces of bone or by the force of the injury. These
complications may be more serious than the fracture itself.
○ organs
○ blood vessels
○ tissues
○ nerves
If a nerve is damaged, the body function it controls will be impaired.
Damage to a sensory nerve could result in numbness in the affected
area, while damage to a motor nerve could result in paralysis.
○ spine
Damage to the spinal cord can cause serious and permanent paralysis,
which means that it must be protected from further damage during first
aid, especially if there are neck or spinal injuries. [The backbone protects
the spinal cord. All nerves leave the brain via the spinal cord and then
branch out at various points along the spine, depending on their function.
For example, nerves controlling the arms branch out in the neck; nerves
controlling the legs branch out of the lower spine.]
●
missed injuries
Warn against the often highly visible nature of fractures causing less obvious
conditions to be missed.
●
shock
Shock will also be present, particularly with breaks of the major bones.
Dislocation
Displacement of one or more bones at a joint
A dislocation is the displacement of a bone end that forms part of a joint eg, hip, ankle,
shoulder, or elbow. The signs and symptoms are similar to those of a fracture, and
the condition requires medical attention to reset the joint and deal with any collateral
damage.
Treat the same as a fracture
There is no practical difference between a fracture and a dislocation for first aid
purposes: the signs and symptoms of each are the same, as is the first aid treatment
●
hard to distinguish anyway
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do not attempt to reset
Signs & symptoms
Sound
- a 'crack' sound may be heard as the injury occurs.
Visible bone ends
Pain
Deformity
As well as the blow which caused the injury, muscles attached to the bones may
contract (powerfully for strong muscles like the thigh), causing deformity.
Crepitus
- the grating sound made by ends of bone grinding together.
Tenderness
Swelling/bruising
Loss of power
Movement may be difficult or impossible.
Shock
Some of the signs and symptoms of shock may be present, depending on the severity
of the fracture.
Treatment
To link to the later practical lesson, give advice on the general treatment for breaks
and dislocations. Explain the importance of immobilising the injury by splinting and the
special importance of immobilisation for spinal injuries, when and how to use gentle
traction, how to dress open fractures and considerations during transport.
Immobilise where lying
- to avoid further damage, especially to blood vessels and nerves. If a fractured pelvis
is suspected, discourage the casualty from urinating: emptying the bladder may cause
it to tear, bringing a serious risk of infection.
Steady limb until splinted
- to avoid further damage, and reduce pain. Only move the limb if absolutely necessary
eg, to put it into a position where it can be splinted. Support the limb on each side
of the break. Beware of compromising blood vessels and nerves: do not attempt to
reduce the fracture (realign the bones) or push back exposed portions of bone.
Support in most comfortable position
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Theory Lessons
Dress open fracture before splinting
Transport slowly and deliberately
Someone must coordinate helpers' efforts to lift and transport the casualty.
Don’t miss other less obvious conditions
Reiterate the warning about the often highly visible nature of fractures causing less
obvious conditions to be missed.
Treat for shock
Nil by mouth
because the casualty may need a general anaesthetic in hospital.
Evacuate to medical facility
Practicalities
Include advice on the practicalities of first aid, such as the length and rigidity of splints,
how the casualty's own body can serve as a splint, use of padding, use of natural
hollows to insert bindings, where to place knots, elevating the injury, and the effects of
swelling on the tightness of bindings.
Uninjured limbs make good splints
Splints need length & rigidity
Padding
Natural hollows
Knots away from injury
- on the uninjured side of the limb, or over the splint.
Don’t bind too tightly
Raise injury if possible
Elevation will help reduce bleeding and swelling.
Summary
Anatomy
Sprains and strains
Fractures and dislocations
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Other CONDITIONS
Lesson Objectives
This lesson covers the recognition and treatment of a number of conditions not covered
elsewhere. They include miscellaneous non-DCI pressure injuries; the relatively
common life-threatening illnesses stroke (referring to the national ActFAST campaign)
and heart attack, together with serious head injury and blast injury; and various injuries
arising from the diving environment - marine animal stings, seasickness, hypothermia,
hyperthermia, and exhaustion
Achievement Targets
At the end of this lesson students should know the signs, symptoms and treatment
for:
● mask, ear, sinus and dental barotrauma
● the life-threatening conditions severe head injury, stroke, heart attack, and blast
injury
● stings from sea creatures
● seasickness
● hypothermia
● hyperthermia
Other Conditions
Contents
Barotrauma
The first part of this lesson covers minor barotrauma: mask, ear and sinus problems,
and tooth cavities. For these topics draw on the knowledge that the students will already
have acquired during their diver education. This part of the lesson should be very much
a revision session concentrating on ensuring that the students can recognise the
conditions and know what first aid actions to take.
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mask squeeze
ear problems
sinus problems
teeth
Life-threatening conditions
These conditions are all life-threatening, and require immediate medical attention.
Stroke and heart attack are included because, after cancer, they are the two most
common causes of death in the UK, and the brain damage caused by strokes makes
them the largest cause of adult disability. In most years, at least one person will suffer
a stroke or heart attack whilst on a diving event in the UK.
●
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severe head injury
stroke
heart attack
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Theory Lessons
blast injury
Others
The conditions in this group can be serious, but in the diving situation are normally
fairly mild but common.
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stings from sea creatures
seasickness
hypothermia
hyperthermia and exhaustion
Mask squeeze
Inadequate equalisation on descent
● bruised / swollen facial tissues
● bruised / haemorrhaged eyes
● self healing
Treatment
● reassurance
● medical attention if painful
● refrain from diving until clear
Ear problems
Cover the various ways in which barotrauma to the ear can occur (taught in lesson OT3
of the BSAC Ocean Diver course). Burst eardrum is one of the most common non-DCI
injuries in the BSAC Incident Reports.
Structure
Describe the structure of the ear, as it affects diving.
Causes
● inadequate ear clearing on descent
● tight hood on descent
● blocked eustachian tube on ascent
Signs and Symptoms
● pain
● dizziness/vertigo
● hearing disturbances
● deafness
● bleeding from ear
Treatment
● cover ear and allow drainage
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refrain from diving
Ensure that the dive manager is informed of any casualty who has reported ear
problems. The casualty should not take part in further diving until the problem
has cleared up.
●
medical attention for deafness, or if unresolved
If deafness or ringing in the ears occurs, the casualty should get medical
attention straight away, because some ear injuries can be repaired if treated
early, but if they are not permanent deafness can result. All casualties should be
advised to consult a doctor if symptoms persist.
Sinus problems
Review sinus problems (taught in lesson OT3 of the BSAC Ocean Diver course).
Structure
Review what the sinuses are: cavities in the skull, connected to the nasal passages.
Causes
● diving with a cold
Mucus can block the passages which connect the sinuses to the nose. Before diving,
this is only a problem in that it prevents the sinuses draining properly, it leads to the
stuffed up feeling that comes with a cold, and it may be a source of infection. During a
dive, if equalisation does not occur, the membranes lining the sinuses will swell towards
the low pressure inside the blocked sinuses, and may rupture causing bleeding.
Signs and symptoms
● blood in the mask
● sinus pain
Treatment
● painkillers
● medical attention if severe
Teeth
This topic is mentioned in lesson OT3 of the BSAC Ocean Diver course.
The diagram of a tooth should be used to cover the point that there are spaces inside
the tooth which may be at a different pressure from the gas in the diver's mouth.
Cavities through the enamel may arise through decay or faulty fillings.
[It should not be necessary to refer to the detailed labelling on the diagram (unless
some of the students are dentists).]
Cause
● air pockets trapped behind fillings
● cavities with narrow openings
Signs & symptoms
● pain during ascent / descent
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dislodged fillings / split tooth
bleeding from gums
Treatment
● painkillers
● pad to prevent further damage
● refer to dentist
Severe head injury
A severe head injury, if not correctly treated, can cause serious damage to the brain
and always requires urgent medical attention.
Brain injuries can occur when the skull is accelerated or decelerated rapidly. This
happens if the head is moving and strikes a fixed object, or if the head is struck by a
fast moving object. In either case the brain may be damaged when it first strikes inside
of the skull or when it rebounds, as illustrated by the diagram on the VA...
Signs and symptoms – blow to head plus:
The following signs and symptoms are indicative of a severe head injury if they follow
a blow to the head. If not they may still indicate a serious condition such as stroke or
DCI, but may sometimes be the result of a lesser condition. If in doubt get medical
advice.
●
headache worsens, or lasts over 6 hours
A lasting headache which worsens, or is still present over six hours following the
injury.
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extreme or persistent sleepiness
Extreme difficulty in staying awake, or still being sleepy several hours after the
injury.
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two or more bouts of vomiting
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unconsciousness, however brief
Unconsciousness, either for a short or extended period of time.
unequal pupil size
straw coloured or blood stained fluid from nose or ears
Straw coloured or blood stained fluid coming from the nose or ears. This is
cerebrospinal fluid which normally surrounds the brain.
severe dizziness or loss of balance
confusion or strange behaviour
problems with memory
unable to use part of body eg, arm or leg
Not being able to use part of the body, such as weakness in an arm or leg.
difficulty seeing or double vision
slurred speech
unusual breathing patterns
ringing or deafness in one or both ears
seizure or fit
Having a seizure or fit (when your body suddenly moves uncontrollably).
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Severe head injury
Treatment
● immediate medical attention
If any of these symptoms are present, particularly loss of consciousness (even for
a short period of time), you should get the casualty to a medical facility. Access to
medical imaging and specialist treatment may be needed.
[The image on the VA is a head MRI, illustrating the point that the injury itself is
invisible and needs highly specialised resources for diagnosis and treatment.]
●
●
●
give oxygen (divers only)
treat other injuries
do not dive or drive
Stroke
ACT F.A.S.T. is a national government campaign introduced in 2009 aimed at
helping people to recognise the signs of stroke, and act to save lives and reduce the
damage caused. Most of the information in this section is taken from the campaign
documentation.
Disruption of blood supply to brain
A stroke is a medical emergency where the blood supply to the brain is disrupted,
usually by a blood clot or a burst blood vessel. When the blood supply is restricted or
stopped, brain cells begin to die. This can lead to brain damage and possibly death.
The signs and symptoms of a stroke vary from person to person, but they usually begin
suddenly. As different parts of the brain control different parts of the body, symptoms
will depend upon the part of the brain that has been affected and the extent of the
damage.
The main stroke symptoms and first aid action can be remembered with the word
FAST: Face-Arms-Speech-Time. Symptoms in the FAST test identify about nine out of 10
strokes.
●
Face
The face may have fallen on one side, the person may not be able to smile, or
their mouth or eye may have drooped.
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Arms
The person with suspected stroke may not be able to raise both arms and keep
them there, because of arm weakness or numbness.
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Speech
There may be slurred speech.
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Time
It is time to dial 999 [or issue a distress call on VHF] immediately if you see any of
these signs or symptoms.
Other signs and symptoms
Severe head injuries, and some forms of DCI, may produce similar symptoms.
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dizziness
communication problems
problems with balance and coordination
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difficulty swallowing
severe headaches
numbness/weakness/paralysis of one side of body
loss of consciousness (in severe cases)
There is a related condition known as a transient ischaemic attack (TIA), where the
blood supply to the brain is temporarily interrupted. The symptoms of a TIA are the
same as for a stroke, but they only last from between a few minutes to a few hours, then
completely disappear. TIAs should be treated very seriously as they are often a warning
sign that a full stroke is coming. There is about a one in five chance that those who
have a TIA will experience a full stroke during the four weeks following it.
Immediate medical attention
Prompt treatment is essential because the sooner a person receives treatment for a
stroke, the less damage is likely to happen. Even if the symptoms of a stroke disappear
casualties should still go to hospital for an assessment because there is a risk that
they may have had a TIA and be about to have a full stroke.
Heart attack
Most heart attacks can be successfully treated if immediate medical help is provided.
The sooner the treatment, the more effective it will be, and the greater the chance of
survival.
Disruption of blood supply to heart
● chest pain
This may vary from a crushing central chest pain to mild chest discomfort. The
pain often starts in the chest and then travels to the neck, jaw, ears, arms
and wrists. Sometimes, it travels between the shoulder blades, back, or to
the abdomen. It can last from five minutes to several hours. Moving around,
changing position, or resting, will not stop, or ease, the pain. The pain may be
constant, or it may come and go, and feel like pressure, squeezing, or fullness.
●
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shortness of breath
clammy, sweaty, and grey complexion
dizziness
nausea and vomiting
restlessness
coughing
general feeling of being unwell
Treatment
● 300mg aspirin
If you are having a heart attack, you will normally be given a one-off 300mg
dose of aspirin. This helps to prevent the blood clot in your coronary artery from
getting bigger. Ideally, it should be chewed, or taken dissolved in water, to ensure
that it gets into your bloodstream as quickly as possible.
Check if the casualty is taking heart tablets (such as nitrates), and if so help the
casualty take them as prescribed.
●
immediate medical attention
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lay down, TLC
give oxygen (divers only)
BLS if necessary
AED if necessary and available
An AED can reset a heart which is not beating properly, which is often the case
with heart attacks and serious diving injuries. The BSAC Automatic External
Defibrillator course provides the training needed to use this valuable type of
lifesaving equipment.
Blast injury
Blast injuries will be a new topic to most students. In the sport diving field the most likely
situation will be a blast injury sustained in air - from, say, a diving cylinder exploding
while being charged. Casualties from such an explosion would have very dramatic
injuries. Casualties from underwater explosions may, however, have no visible injury
despite profound internal damage. Underwater explosions are unlikely in sport diving
and consequently the majority of the time spent on blast injuries should cover the case
in air.
Explain the characteristics of blast injuries, covering both visible and potential internal
damage. Much of the spectrum of injury sustained in a blast incident (wounds, bone
damage, shock) is covered in the earlier lessons and this should be referred to by
extracting the appropriate information from the students.
Causes
● exploding cylinder
● burst flailing hose
● explosives
Injuries due to
● overpressure
○ bruising
○ tissue separation
○ soft tissue damage
○ limb damage / amputation
●
shrapnel
○ high energy particles
○ multiple wounds
○ ‘gunshot’ wounds
Blast injury
Blast injuries can be devastating. The picture in the VA shows a right hand damaged
by explosives.
Treatment
● ABC
Blast injuries are often life-threatening. Deal with the priorities of Airway
Breathing Compressions first.
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counter bleeding
treat fractures
make casualty comfortable
treat for shock
arrange urgent evacuation
Stings from sea creatures
Hazards
In the UK, there are very few types of venomous creature. The main hazards for divers
are some types of jellyfish (Lion's mane jellyfish cyanea capillata, pictured top, and
cyanea lamarckii, pictured bottom). Their stings can be painful but are not lethal.
Overseas, especially in tropical waters, there are more types of venomous creature,
and some of them can inflict serious or even lethal stings. Hazards include fish (eg,
lionfish, stonefish, scorpion fish), medusa (eg, box jellyfish), molluscs (eg, cone shells,
blue-ringed octopus), and sea snakes. There may be specific treatments for the local
venomous creatures, so do some research if you are to be the first aider on an overseas
diving expedition, unless there will be a competent local first aider on hand.
The advice in this section is aimed at the UK situation, although the general approach
is applicable anywhere.
●
UK rarely serious
Signs & symptoms
● contact with animal
● pain
● rash and/or swelling
● shock
Treatment
● remove jellyfish stings
Jellyfish tentacles contain large numbers of stinging cells, which will continue
to fire long after the tentacles have broken up. First aid involves removing the
stinging cells from the skin without causing more of them to fire, and without first
aiders getting stung themselves.
○ do not touch
Wear gloves or use a stick. Remember that the cells left on whatever
protection you use will still sting, so do not, for example, touch exposed
parts of your body with a gloved hand.
○ do not use fresh water
Fresh water may cause stinging cells to fire.
●
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treat symptoms
get medical help if serious
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Seasickness
Sea sickness is a common ailment that can have serious consequences when diving.
Explain its causes, what steps can be taken to prevent or minimise it, types of anti-sea
sickness pills and their implications, the treatment of sea sickness and the potential
implications of attempting to dive while sea sick.
Cause
The principal cause of motion sickness is believed to be the brain receiving conflicting
inputs from different sensory systems: the balance mechanism detects that everything
is moving, but the eyes show that objects are stationary relative to one another.
●
●
motion affects balance mechanism
people differ in susceptibility
Prevention / minimisation
● healthy eating and drinking
Hangovers, meals lying heavy on the stomach etc, predispose to seasickness.
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watch horizon, minimise motion
Looking at the horizon helps prevent motion sickness because the eyes than see
objects on the boat in motion relative to the horizon. Similarly, trying to read, or
similar tasks such as assembling diving equipment, makes things worse because
the eyes see no relative motion at all.
Being at the centre of the boat lengthways and widthways minimises the amount
of pitching and rolling that is felt.
●
●
comfortable clothing
proprietary remedies
There are several types of over-the-counter medicine available, as well as
some herbal remedies (the main ingredient is usually ginger) and a variety
of wristbands and bracelets. There is very little scientific evidence that these
remedies are effective, except for the medicines, which carry risks for divers. The
advice from the UK Sport Diving Medical Committee on sea sickness medication
is as follows.
"The problem with sea-sickness medication is that some of these tablets may
make you drowsy and may therefore predispose you to nitrogen narcosis.
It is strongly advisable to find the medication which best suits your body.
First, you should purchase a type recommended by your local pharmacist (eg,
Stugeron), and take a test dose at a time when you are not driving or diving. If
you become drowsy, you will know the medication does not suit you, and you
must then try another type. This procedure should be repeated until you find one
which does not make you drowsy. It is important to note that the one which suits
you best may not suit your buddy at all. This is nothing to worry about and is due
to differing body metabolism.
Your initial dives on this medication should be shallow and depth should be
gradually increased over subsequent dives in order to minimise the possibility
of adverse effects on a deep dive. Beware of the possible additive effects of this
medication with prolonged use. If any drowsiness is experienced, you should not
take a dose on that day.
At the start of a new diving season, prior to diving, it is advisable to retest yourself
in this way to ensure that your chosen medication still suits you.
UKSDMC May 1996"
Signs & symptoms
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nausea, vomiting, pallor, headache
Prolonged vomiting may lead to dehydration, which is a predisposing factor for
DCI.
●
inability to perform tasks
Seasickness casualties should not dive or act in any dive management role if
their ability to function properly is affected.
Treatment
● lay / sit down, keep warm
● secure to prevent falling (overboard)
● remove to more stable environment
Hypothermia
While the incidence of hypothermia has become less with the widespread use of
drysuits, cases still appear in the BSAC Incident Report every year. Explain what it is,
how it can come about (out of the water as well as in), how to recognise it and what to
do about it.
Body temperature <35°C
Causes
● inadequate thermal protection
● water conducts heat 25 times faster than air
● wind chill/evaporation
Signs and symptoms
● 35-37°C cold, lethargic, pale skin
● 33-35°C slurred speech
● 32°C intense shivering, low comprehension, irrational
● 30°C shivering stops, lack of coordination, slow pulse and breathing
● 27°C unconscious
● 24°C death
Hypothermia
Treatment
● insulate, lay down, keep quiet
● hands and arms not touching trunk
● warm sheltered environment
● replace or cover wet clothing
● hot sweet drinks
● recovery position if unconscious, BLS if necessary
● evacuate to medical attention
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Do not
The following will cause more blood to flow near the surface of the body, losing heat.
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give alcohol
rub or massage limbs
allow casualty to exercise
In extremis
Only attempt this if there is a long delay before medical help arrives.
●
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gentle heat to trunk only
rewarm at original cooling rate
Hyperthermia
Hyperthermia in the form of heat exhaustion (body temperature 37-40°C) is more of a
problem for drysuit wearers. It is no longer just a problem in warmer climates. Explain
how it can come about (not just by hot weather but also exercise), its recognition and
treatment.
[Heat stroke (body temperature >40°C, and a life-threatening condition) in unlikely in
the UK and should only be included when courses are run in those areas of the world
which experience very hot climates.]
Causes
● exercise in heat and/or excessive clothing
● loss of salt through sweating and/or D & V
D&V is diarrhea and vomiting.
Signs and symptoms
● casualty exhausted and restless
● headache, dizziness, nausea
● cramps in lower limbs
● pale, clammy skin, normal or falling temperature
● fast shallow breaths, weak rapid pulse
Treatment
● lay down in cool place
● water or rehydration drink
Give plenty to drink. This should either be water, or a rehydration drink such as
a sports drink. You can make a rehydration drink by adding one level teaspoon
of salt to a litre of water, plus sugar and/or flavouring to taste. Avoid alcohol or
caffeine as they can increase levels of dehydration.
●
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recovery position if unconscious
evacuate to medical facility
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Theory Lessons
Exhaustion
Causes
● overexertion
● aggravated by heat, cold, depth, illness
Signs and symptoms
● deep laboured breathing
● headache and confusion
● unable to respond to mental and physical demands
Exhaustion is a more profound condition than just 'needing a rest'. Most divers
might need a breather after a bout of strenuous effort, but will be able to think
and move while recovering, even if temporarily unable to continue at their original
pace. An exhausted diver will be helpless, unable to move or think in any effective
manner.
Treatment
● stop activity
● lay down and keep quiet
● Exhaustion = common sign of DCI
Summary
Mask squeeze
Ear problems
Sinus problems
Teeth
Severe head injury
Stroke
Heart attack
Blast injury
Stings from sea creatures
Seasickness
Hypothermia
Hyperthermia
Exhaustion
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OPEN FORUM AND COURSE
DEBRIEF
Lesson Objectives
In this brief lesson the key points which the students should take away with them
are summarised, course documentation is handed out, and students are given a final
opportunity to ask questions.
Achievement Targets
At the end of this lesson students should:
● be able to set the specific skills learnt on the course into the context of the basic
principles of first aid
● understand how FAD fits into the suite of BSAC rescue skills courses
● appreciate the benefits of attending further rescue skills SDCs
● have had an opportunity to ask any remaining questions
Open Forum and Course Debrief
If the logistics for the course are such that it is more convenient to do so, the contents
of this session should be delivered informally 'in the car park' as the final debrief at the
end of the course.
Summary
Summarise by reiterating the objectives of first aid and that they should aim to do the
minimum necessary to achieve those objectives.
Preserve life
Limit the effects
Promote recovery
Do the MINIMUM necessary
Conclusion
Round the session off by putting the course in its proper context as one of an integrated
suite of rescue skills courses. Encourage students to participate in all the others so
that the knowledge and skills they gain will enable them to contribute more effectively
across the wider spectrum of diving safety.
Attending an SDC will give them a fun day out; lots of practice, under the guidance
of experienced instructors; several Dive Leader lessons signed off in a single day if
they are learning rescue skills for the first time; and a quick and easy way to "practise
practise practise" and stop the rescue skills they already have getting rusty.
Other BSAC rescue courses
● Dive Leader
The BSAC Dive Leader course includes all of the content of the OAA and PRM
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SDCs. Sports Divers who complete the SDCs get signed up for the corresponding
parts of the Dive Leader course.
○ Oxygen Administration
OAA teaches the administration of oxygen as a means of increasing the
effectiveness of first aid treatment of diving accidents. It includes Basic
Life Support and deals with diving-specific injuries such as DCI.
○ Practical Rescue Management
PRM teaches divers how to manage the resources at their disposal in
order to make the most effective use of them in a rescue situation.
Mention that, for those who wish to further their knowledge of first aid, a variety of
longer courses from 3 days upwards is available from organisations such as the Red
Cross.
●
AED Workshop
AED trains divers and others involved in BSAC diving activities, in the use of
Automated External Defibrillators (AED) during a diving emergency situation, with
particular attention to precautions required in the diving environment.
●
Lifesaver and Advanced Lifesaver
These awards test the personal rescue skills taught in the BSAC Diver Training
Programme.
The Lifesaver Award examines lifesaving proficiency specifically applicable to
divers under pool or sheltered water conditions. A secondary aim is to examine
the ability of divers to make use of their rescue skills in more general non-diving
situations.
The Advanced Lifesaver Award examines lifesaving proficiency specifically
applicable to divers in realistic open water conditions, and also covers first aid for
injuries likely to be encountered in diving and diving-related activities.
Course documentation
Hand out Student Packs and any other material, as necessary
Open forum
Use the open forum session to deal with any questions which have not already been
answered and to tie together any loose ends.
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CASUALTY EXAMINATION
Lesson Objectives
A prompt and accurate evaluation of the casualty's injuries, allowing the correct first aid treatment to be
rapidly applied, could be the difference between life and death. This lesson deals with the evaluation
of non-diving conditions. Casualty evaluation for a diving incident is covered in lesson DT4 of the BSAC
Dive Leader course, and in the Oxygen Administration Award, where the appropriate conditions are
addressed.
The lesson follows the head-to-toe method of casualty assessment using the check list included in the
Student Notes.
Achievement Targets
At the end of this lesson students should:
● be able to conduct a casualty examination using the head-to-toe method
● be able to find a pulse quickly and reliably
● have used the FAD Casualty Assessment Checklist
Equipment Needed
When examining the eyes, small torches will be required to demonstrate the response of the pupil to light.
To avoid eye damage, they should not be too bright.
A supply of FAD Casualty assessment checklists, sufficient for each student
Lesson Contents
1.
Physical examination
Explain the method used for the examination, introduce the checklist, and cover the recording of incident
details (history), responsiveness (include a link to the AVPU classification taught in Dive Leader, PRM, and
OAA), and symptoms reported by the casualty. Remind students that symptoms can only be reported by
the casualty, while signs are detected by the first aider (and maybe the casualty as well).
If necessary, point out that the FAD Casualty Assessment Checklist covers a different range of conditions
from the BSAC Casualty Assessment /Incident Procedure form, and the two are not interchangeable.
●
Method: head-to-toe, minimal movement of casualty, compare both sides of the casualty's body.
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History: description of incident
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Responsiveness: sight, speech
●
Symptoms: information from the casualty
2.
Assess and record
Follow the head-to-toe method of casualty assessment using the check list included in the Student Notes,
and Appendix B.
When checking for subtle changes in response or appearance during a casualty examination, it is important
that the students know what the normal response or appearance is like. Each type of examination should
be demonstrated and then student pairs should perform them on each other.
●
Head
o skull: swelling, indentation
o face: colour, skin, temperature, breathing
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o eyes: pupil size, response to light
o ears: hearing, blood, fluid
o nose: appearance, blood, fluid
o mouth: breathing, odour, wounds, irregularity, discolouration
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Neck: loosen clothing, warning medallions, vertebrae, tenderness, bruising
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Trunk: chest movement, symmetrical collar bones and ribs, wounds, tenderness, incontinence
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Back and spine: vertebrae, swelling, tenderness
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Upper limbs: check movement, bruising, swelling, deformity, warning bracelet, feeling
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Lower limbs: check movement, bruising, swelling, deformity, feeling
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Feet: movement, feeling, colour, deformity
3.
Pulse
Demonstrate the method of taking a pulse, at various points on the body, including the carotid pulse.
Observe the students measuring their partners' pulses (preferably carotid), and check the results. Get
them to repeat the exercise if not satisfactory.
4.
Monitoring
The initial condition is not always the whole story and consequently the casualty's condition should
be continuously monitored as subsequent changes in condition may give vital information to medical
personnel. Explain this to the students, and point out that the form in the Student Notes has space to do
this.
Skills Performance Standards
At the end of this lesson, students should be sufficiently competent to achieve the following skill
performance standards without supervision:
Assess and record - carry out accurate assessment of each element (head to feet) of a casualty examination
with minimal movement of the casualty, and record the information legibly.
Pulse - quickly and reliably find their partner’s pulse (preferably the carotid).
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BANDAGING
Lesson Objectives
This is a highly practical lesson which is intended to give each student hands-on practice at dealing with
a variety of scenarios in which a wound needs bandaging. The lesson format consists of an instructor
demonstration of all the aspects covered, followed by student practice in pairs.
Achievement Targets
At the end of this lesson students should:
● be confident and competent in their ability to deal with any type of wound using whatever
materials are to hand
● understand what to do when a dressing fails to control bleeding
● be able to elevate and/or immobilise the site of an injury
● know how to apply bandages which do not restrict circulation.
Equipment Needed
A selection of bandages and dressings as might be found in a first aid kit, and other items suitable for
improvisation.
Lesson Contents
1. Demonstration
Give a demonstration of all the bandaging techniques to be covered in the session (to a certain extent,
this will depend on the scenarios which have been chosen). Bandaging demonstrations should cover
not just control of bleeding but also immobilisation of the affected area (eg, pad gripped in palm, glove
with fingers folded over secured over balled fist, arm in sling) and how to cope with embedded foreign
objects.
Bandages which fail to control bleeding should never be removed: place additional bandages on top.
Stress improvisation using any materials available - infection is of secondary importance to controlling life
threatening bleeding.
2. Bandaging scenarios
Get the students to deal with a number of wound scenarios, working in pairs. The practical exercises
should include the use of normal and improvised dressings/bandages.
Suitable scenarios for practice are:
●
badly gashed palm of the hand
●
lacerated wound of the lower leg
●
wound at a site of changing body contour (eg, elbow, knee or ankle)
●
puncture wound of the abdomen
●
scalp wound (using a triangular bandage or improvised triangular bandage)
●
wound of the lower arm with an embedded foreign object
●
wound where the initial bandaging fails to stem the bleeding (this scenario must be included)
●
additional or different scenarios may be introduced at the instructor's discretion.
During the student practice ensure that bandages are not applied too tightly.
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Ensure that where bandages are applied it is always possible to check the circulation at limb extremities
beyond the bandage.
Where appropriate ensure that suitable techniques are employed to elevate the site of the injury.
Skills Performance Standards
At the end of this lesson, students should be sufficiently competent to achieve the following skill
performance standards without supervision:
Bandaging – confident and competent to bandage the types of wound likely to be encountered in diving
situations.
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Practical Lessons
First Aid for Divers Instructor Manual
DRESSINGS, SPLINTING AND MOVING
CASUALTIES
Lesson Objectives
This session should build on the advice on the given in previous lessons regarding the nature and treatment
of the various conditions, by practical demonstrations and student exercises, where each student gets
hands-on practice at dealing with a variety of injuries of a type likely to be encountered in diving situations.
The emphasis should be on improvisation using the various items of diving equipment.
The instructor gives a demonstration of methods for moving a casualty.
For convenience the lesson may be split into two sessions separated by a short break for refreshments,
for which additional time should be allowed.
Achievement Targets
At the end of this lesson students should:
● be confident and competent to deal with the types of injury likely to be encountered in diving
situations
Equipment Needed
A selection of items as might be found in a first aid kit, and other items likely to be present at a dive site,
suitable for improvisation.
Lesson Contents
1. Moving the casualty
Appropriate 'casualties' should be used to demonstrate moving the casualty, using such methods as a
blanket lift. Involve as many of the class in the demonstrations as possible
5. Dressing and splinting
The students should work in their pairs with each pair being given a different injury to treat, one of the
group acting as the casualty and the other as the first aider. The emphasis should be on improvisation
using the various items of diving equipment.
Suitable injuries include:
●
broken collar bone
●
break of the lower arm
●
elbow injury resulting in flexed arm with fixity of movement
●
broken femur
●
crushed hand
●
open break in the lower leg
●
broken ankle
●
broken ribs
●
broken pelvis
Once the 'casualty' is suitably attended to, the 'first aider' of each pair should then explain to the whole
class what has been done and why. Draw out some of the hazards that have to be dealt with for particular
injuries egs, torn femoral artery with broken femur, punctured lung with displaced fracture of the ribs,
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etc. 'Casualty' and 'first aider' should then swap roles and be given a completely different type of injury to
treat. This swapping of roles and expansion of the spectrum of injuries attended to should then continue
for as long as time allows
Skills Performance Standards
At the end of this lesson, students should be sufficiently competent to achieve the following skill
performance standards without supervision:
Dressing and splinting – confident and competent to deal with the types of injury likely to be encountered
in diving situations.
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Appendices
First Aid for Divers Instructor Manual
Appendix A
Incident statistics
The following charts are based on analysis of all incidents reported under the category "Injury/illness"
in the BSAC Diving Incidents Reports for the years 2000, 2005 and 2008. "Injury/illness" includes
almost all reported incidents involving the type of injury covered in FAD. It excludes underwater injuries
such as DCI, drowning and gas toxicity. There were 81 "Injury/illness" incidents, just over 6% of the
total of all types of incident.
The charts indicate the relative frequency of different types of accident and of different types of injury.
It is likely that the actual frequency of injuries requiring first aid is somewhat higher than the number
of reported incidents suggests: some others of similar severity, and many minor injuries, will have
occurred and gone unreported.
Injury types
Incident types
w ound
14%
diving (not DCI)
20%
other
27%
chest pain/heart attack
9%
concussion
10%
other
20%
trailer
7%
propeller
4%
illness
14%
56
eardrum
19%
fall
17%
heat/cold
11%
hypothermia
9%
fracture/sprain/strain
13%
exhaustion/hyperthermia
6%
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First Aid for Divers Instructor Manual Appendices
Appendix B
FAD Casualty Assessment Checklist
Casualty name
Date
Time
History - description of incident
Responsiveness sight, speech
Symptoms - information from casualty
Head Skull – swelling, indentation; Face – colour, skin, temperature, breathing; Eyes – pupil size, response to light
Ears – hearing, blood, fluid; nose – appearance, blood, fluid; Mouth – breathing, odour, wounds, irregularity, discolouration
Neck – loosen clothing, warning medallions, vertebrae, tenderness, bruising
Trunk
– chest movement, symmetrical collar bones and ribs, wounds, tenderness, incontinence
Back & spine – vertebrae, swelling, tenderness
Upper limbs – check movement, bruising, swelling, deformity, warning bracelet, feeling
Lower limbs - check movement, bruising, swelling, deformity, feeling
Feet - movement, feeling, colour, deformity
Changes - record time & change
FAD Casualty assessment checklist
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