Let’s face the facts, diving accidents do happen. Thankfully not too often, but as an active scuba diver the law of probability states that sooner or later I will encounter some kind of first aid emergency. With this in mind I would hate to be unprepared or unable to help someone in their moment of need. So when I saw the advert on DAN Europe’s website promoting the diver medic technician (DMT) course run by Code Blue Education, I thought this was the perfect time for a refresher on the latest medical techniques and procedures.
As well as covering the basic ABC’s the 2-week (80 hour) course entered into the realms of suturing, IV cannulation, catheterisation and dealing with a real life pneumothorax. I was really looking forward to the suturing session but the thought of catheterising a patient didn’t really fill me with inspiration. In fact I went weak at the knees just thinking about the procedure.
My last dabble with any form of medical training was a St John’s Ambulance first aid at work course several years ago. I was worried that my level of knowledge would be way below the required standard, but Chantelle Taylor-Newman, Director of Code Blue Education, reassured me that my background would be fine. I didn’t need to bring along any materials as everything from tea, coffee, soft drinks and chocolate muffins to all the course notes and even my own personal stethoscope would be included. I was already starting to get delusions (but then again, Doctor Philpott did have a certain ring to it!).
Chantelle said the DMT course is aimed at commercial and recreational divers. It’s actually an offshore requirement to have one DMT in each commercial diving team. Chantelle, who is also a certified PADI Divemaster, said “The DMT course is designed for commercial divers, but these days there seems to be more accidents in recreational diving, so I feel that it should be taught to all recreational divers as well.”
Code Blue Education is based in Brentford, London. They offer the full range of DAN courses up to Instructor level. The DAN/IMCA (International Marine Contractors Association) accredited DMT course is a new addition to their medical training portfolio. Chantelle said “We are looking at running the course every 2-3 months.” The content is currently around 40% theory and 60% practical work. There is a mid-week multiple choice exam followed by a final written and practical exam watched over by a practising medical professional.
Chantelle gave me some website links for pre-course reading, so when I turned up on Monday morning, I was raring to go. Even having to give a personal introduction in front of the group couldn’t dampen my enthusiasm. There was a good mix of people from different countries and job backgrounds. Andrea had just completed a commercial job looking for dead bodies on the Concordia cruise liner in Italy, and Oliver had been welding pipe work inside a sewage tank somewhere in Oz. Jason was studying economics in Scotland and Chris was working for the forestry commission in the home counties. The white collar workers were represented by Morne from DAN South Africa and Clive who owned 2 decompression chambers in Cyprus.
The first two days mainly consisted of theory focusing on physiology and basic first aid principles. Chantelle emphasised that hygiene was extremely important by saying “you can find faecal matter just about everywhere” (that’s such a nice thought!). Guest speaker Cary Marcelo, a care procedures and resuscitation Instructor working at Harley Street, went through the signs, symptoms and treatment for patients suffering from a variety of injuries. We had quite a few acronyms to remember. ABCDE and SAMPLE were the most widely used. Cary’s catchphrase was “Always treat what kills first.” During the practical sessions everybody had to wear gloves and use the oral nasal masks. I never realised how easy it was to use an AED (automated external defibrillator) – the unit basically talked me through the whole procedure. We also went through how to check blood pressure using a sphygmomanometer and a stethoscope.
Police diver Steve McKenna turned up mid-week to go through wounds, bleeding and fractures. Steve has worked with the marine unit for the past 14 years and gets called out on jobs anywhere in London. He had some very interesting (and gory) stories about past investigations. I can still visualise the picture showing a severed penis! Steve’s catchphrase was “We are going to lose people.” Steve explained that even with first aid treatment some people will die; in fact, the actual quoted figure is a 5% survival rate if an accident happens out on the street.
The day wouldn’t be complete without a few new acronyms to memorise. This time SAFE and RICE seemed to be the favourites. By far the best product Steve showed us was Celox. The haemostatic granules were developed for military use to stop severe bleeding. They are now being used by civilian paramedics. DAN even sells the packs on their website. The practical session using spinal boards, scoop stretchers and cervical collars gave everybody a chance to stretch their legs. I soon realised that trying to manoeuvre a stretcher and patient up and over objects and around tight corners is not an easy task.
To finish off the week we had a theory day on diving physics and diving related injuries. I already knew most of the information from my PADI Divemaster days so this was really just a refresher. Some of the pictures of skin and facial barotraumas (suit and mask squeeze) looked horrendous, but Chantelle reassured us that the injuries had healed up without any permanent injury.
The second week involved more complex procedures starting with IV cannulation. I am not a fan of needles so this was quite an interesting session. We all got to practise on the plastic/rubber training arms that were filled with fake blood. Even I managed to get the procedure right after a few tries. Catheterisation had everybody grimacing apart from Chantelle who seemed to be smiling as she performed the delicate demonstration. Watching someone put a 30cm long catheter inside a penis brought tears to my eyes (it wasn’t a real penis I might add. We used a training manikin). This is one procedure I would not want to do in real life. Morne, from DAN South Africa, pointed out to me that the correct medical term for the male genitalia is a winky!
Doctor Mark Downs was our next guest speaker. Mark is an HSE Medical Examiner. He is one of only eighty doctors in the country that can conduct commercial diving medicals. Mark is an active PADI Divemaster and has been diving for 10 years. We listened to Mark’s presentations on diving related accidents and how to check out a possible bends case. Mark said “the 5 minute neuro exam provides a reliable system to judge the urgency of a diving emergency. It also demonstrates to the diver involved that there is a problem and convinces them to commence oxygen first aid treatment.” Mark’s catchphrase was “Oxygen is the answer to all diving related injuries.” He stated that in two thirds of all DCI cases there will be some kind of neuro damage, which is quite a sobering thought. We looked at the DDRC, DAN and Mark Powell’s neuro assessment sheets and tried them out on each other for good measure.
Before taking the dreaded exams we spent an interesting day with Spencer Phillips at the Diver Clinic’s recompression chamber based in Reading. Spencer has more than 20 years experience in decompression therapy. We sat through an in-depth presentation on the ‘bends’ going through the general causes and treatments. Spencer said he had recently seen an increase in trimix rebreather related incidents quoting one particular case where a woman wasn’t carrying any bale out gas for a dive in the 50-100m range. When the unit failed she came to the surface missing a considerable amount of deco time. Spencer quoted some interesting statistics. He said that in the UK there is a one fatality per 200,000 dives and one decompression related incident for every 5,000 dives. Rapid ascents seemed to be the main problem. Between 70-80% of the cases he treats are Type 1 bends. 98% of symptoms appear within 24 hours, 50% are within the first hour. Spencer said “time to treatment is crucial for getting a good result.”
On the final day everybody passed the written exams and scenarios with flying colours. Code Blue Education’s second ever DMT course had been a resounding success. The problem I find with any course is trying to retain all the relevant information. After 2 full weeks of theory and practical sessions my brain was about to explode. I had thoroughly enjoyed the course, especially the practical scenarios. Having specialists speakers come in and give presentations definitely made the course more interesting and helped increase everyone’s attention span, although on a few occasions listening to different perspectives did lead to confusion as to what was the correct procedure to use.
Going through accident scenarios in a controlled classroom environment is never the same as facing a real life emergency situation. I kept wondering, how would I react? What I do know is Code Blue Education’s DMT course has certainly raised my first aid skill levels, so if there ever was a situation I had a far better chance of helping someone out.