IF YOU HAVE A SUSPECTED DIVE INJURY/ ACCIDENT, CALL:
CWM, SUVA SWITCHBOARD
Ph: 331 3444
Operator will alert the on-duty Hyperbaric Doctor
Once retrieval for treatment is authorised, OCEANIA HOSPITALS should also be notified of an admission, if necessary. Call:
Dr John Alfred
Cell: 9929541
Clinical Coordinator
IMPORTANT – YOU MUST PLACE THE PATIENT ON OXYGEN! IF CONSTANT FLOW, MINIMUM 15 LITRES/MINUTE
IMMEDIATE CARE
In a suspected diving accident, the first question is ‘Did the victim take a breath underwater?’ from a SCUBA tank, hose, bucket, submerged car, or any compressed air source, regardless of depth.
If the answer is no, give CPR and oxygen if needed and evaluate at the nearest medical facility as the casualty is unlikely to require treatment by a diving medicine specialist.
If the injured diver did breathe underwater and only mild symptoms are present (fatigue and itching only), place the patient in the Recovery position if possible and administer oxygen and oral fluids while maintaining close observation for 30 minutes. DO NOT GIVE ORAL FLUIDS TO PATIENTS SUFFERING DIZZINESS OR NAUSEA DUE TO POSSIBILITY OF VOMITING.
If these symptoms do not clear, “ACTIVATE THE HYPERBARIC CHAMBER ALERT”.
If the injured diver did breathe underwater and has serious symptoms, the Dive Operator must accompany the patient and do the following:
- Administer CPR if required with the victim lying flat on his/her back.
- Keep airway open and prevent aspiration of vomit. An unconscious diver should be intubated by trained personnel if possible.
- Administer oxygen by tight-fitting transparent double seal mask at the highest possible oxygen concentration. Do not remove oxygen except to re-open the airway or if the victim shows signs of convulsions.
- Keep victim in the Recovery position if symptoms occurred within 10 minutes of surfacing and steps 1-3 have been completed.
- If convulsion occurs do not forcefully restrain. Turn victim on side (supporting head and neck), maintain airway, sweep away any vomit. Hold victim loosely to prevent self injury and do not forcefully insert any airway or tongue blade, resume oxygen administration.
- Protect the injured diver from excessive heat, cold, wetness, or noxious fumes.
- For conscious patients only, give conscious patients non-alcoholic liquids such as water or fruit juices.
- Call the CWMH – 3313444 and initiate Chamber Alert (see page 8). Hyperbaric Doctor: Dr Akuila Waqanicakau – 976 7267 may not always be available to take calls on the spot.
- If necessary, the Hyperbaric Doctor will advise Transport, then Evaluate and stabilize patient at the nearest Medical Centre/Hospital emergency room prior to transfer to the Hyperbaric Chamber Facility. ENSURE OXYGEN LEVELS ARE AT 15LITRES/MINUTE AND NOT DROPPED TO HOSPITAL NORMS FOR NON-DIVERS
- For Doctors or Paramedics only: Intravenous fluid replacement with electrolyte solutions is preferred for unconscious or seriously injured victims. Ringers lactate, normal saline, or 5% dextrose in saline may be used. Do not use 5% dextrose in water. Intravenous fluid treatment requires professional care. Do not attempt unless you have proper training.
- Should the patient be moved to a Medical Centre the Fiji Government Doctor will stabilize the patient, the Dive Operator must ensure communications are frequent to the Hyperbaric Doctor at the Hyperbaric Unit.
- When you initiated the Hyperbaric Chamber Alert, the Hyperbaric Unit will have put all personnel on a state of readiness i.e. The Chamber, Ambulances and the quickest method for MEDEVAC will be on standby readiness to depart. The Ministry of Health Doctor and Hyperbaric Chamber Doctor must authorize all patients (Fiji Citizens, Beche-de-mer Divers, Tourist/Recreational divers, staff, salvage and commercial dive companies) Medevacs, and treatment at the Hyperbaric Unit.
- The patient should remain on oxygen during transport to Hyperbaric Unit.
- If air evacuation is used, IT MUST BE ARRANGED BY THE HYPERBARIC UNIT. It is critical that the patient not be exposed to decreased barometric pressure at altitude. Flight crews must fly at the lowest safe altitude in un-pressurised aircraft. CAAF have agreed 500 feet weather permitting. It is essential that you the Operator personally ask the pilot to confirm he has been briefed on this critically important aspect.
Full document with reporting procedures and emergency contacts are accessible and downloadable here.
We recommend that all dive operators have a hardcopy of these notes printed and readily available on all dive vessels and offices.