Scuba diving is a fascinating and safe sport – as long as you follow the rules and, even more importantly, understand them. Be prepared for any eventuality.
Text– Benjamin Schulze
Accidents cannot always be avoided. In an emergency, level-headed and calm action is crucial. Good preparation forms the best foundation for minimizing risks. Regular training ensures you react instinctively in critical moments. It’s important to accept that you never stop learning and to remain open to new developments. Because safety in diving is not static. “To be safe, we must constantly adapt our plans and actions to the activity we are undertaking, the environment we are in, the equipment we are using, the people we are interacting with, and the feedback we receive,” says diving expert Gareth Lock on the website inDepth.com in an article about safety culture in diving.
Accident Prevention
The best emergency is the one that never happens. Therefore, here are some basic principles of accident prevention. What follows may sound cliché, but it is meant sincerely and remains relevant: Dive within your limits and in a way that makes you feel comfortable. Only go diving when you are physically and mentally capable. Unfortunately, overestimating of one’s abilities and pushing oneself too hard are frequent causes of accidents. The extent to which these two factors contribute to diving accidents is not reliably recorded. It is estimated that 60 to 80 percent of all diving accidents are due to human error.
Never dive alone. A reliable dive buddy can be life-saving in emergencies. Unfortunately, there is insufficient data on how often the buddy system has successfully prevented accidents. There have only been attempts to approach this difficult question. Nevertheless, always perform a buddy check with your partner before every dive, inspecting both your equipment and theirs.
Pay particular attention to the condition of all regulators and their mouthpieces. Test your breathing gas by briefly breathing from the regulator while still on land. If the air tastes oily or smoky, the base personnel, dive guide, or an experienced diver should be informed. If a problem is confirmed, either the cylinder should be changed or the dive postponed.
Consider beforehand whether the amount of breathing gas will be sufficient for your personal air consumption and the planned dive. If you are unsure, dive conservatively and not at your limit. And talk to your guides if you have any doubts.
With your buddy, check the functions of your buoyancy compensator (BCD) – the inflator and quick releases. This is especially important with an unfamiliar dive partner using rental equipment, as it allows you to familiarize yourselves with the gear. Go through your equipment: is a computer present (every diver should have their own on their wrist – and be able to read and use it)?
Before the dive, discuss the route, depth, dive time, and emergency procedures. What to do if you lose your dive partner? Ensure that all divers know the hand signals and communication methods.
Ideally, but unfortunately unrealistically, every diver would carry and know how to use a surface marker buoy. However, using one requires practice so that you are not overwhelmed in a stressful situation and end up making things worse. If one person per buddy team is capable of safely deploying a buoy, a significant level of safety is already gained.
Inspect everything: The number one accident preventer is the buddy check. It takes little time and prevents errors by both beginners and experienced divers alike.
Of course, the buddy system is also a subject of ongoing discussion, as it assumes an optimally trained and well-practiced dive partner. Unfortunately, reality often looks different, which is why more experienced underwater enthusiasts often say they are better off and safer without a dive partner. This is true to some extent, as long as they can help themselves, which requires training and the correct handling of their equipment. However, in the event of a heart attack or sudden unconsciousness, solo diving quickly becomes fatal, as this sad example shows.
One last tip for accident prevention: The shallow water check at a depth of three to five meters during descent, before going deeper, helps to identify problems early and react to them. This should not just involve asking for an “OK” sign. It’s also about descending together, keeping close distances to be able to help, and recognizing potential equipment problems, such as free-flowing regulator components, by observing bubbles.
Responding to Emergencies
In the following, we describe three possible scenarios that represent relatively frequent emergencies and for which you can prepare with practice.
1. Regulator failure and sudden air shortage can trigger panic. Stay calm – easier said than done, but absolutely essential. Signal your buddy about the problem and use their alternate air source. Begin a controlled ascent to the surface once the situation has calmed down. “Simply continuing the dive” with a defective regulator is strongly discouraged.
Diving alone is dangerous: While not responsible for all diving accidents, solo diving, i.e., diving without a buddy, is often the cause of the most devastating ones.
If your dive partner is not within reach, the only option left is a controlled emergency ascent to avoid drowning. Dropping your weights is not recommended, as this gives up control over your ascent rate and increases the risk of decompression sickness. Use the power of your fins for the ascent. Dropping your weights only makes sense if you can no longer establish buoyancy independently, which is very rare. During a swimming ascent, be sure to exhale any remaining air in your lungs as you ascend to the surface. Protect your head with one hand. Orient yourself to the smallest bubbles you exhale to gauge your ascent rate. If possible, do not overtake them. Establish buoyancy as soon as you reach the surface. Then, send distress signals by making large, waving arm movements, shouting, whistling – in short: using all available means.
Suppose a regulator suddenly starts free-flowing uncontrollably (sometimes called a “freeflow” or “icer”), which tends to happen more often in colder waters. In that case, there is still time to act, even though the strong surge of bubbles causes stress. The regulator is still breathable, so keep it in your mouth. Immediately head to your buddy. Now switch to their octopus (alternate air source) and close your regulator valve. If you have a separately shut-off first and second stage, as is common with cold-water systems, you can help yourself in this situation: put the second regulator in your mouth and close the valve of the faulty regulator yourself or have it closed, and reduce your depth.
All these procedures can be simulated and practiced in shallow water. From the “valve drill,” i.e., independently closing the cylinder valve, to a controlled, swimming emergency ascent (always the last option), training scenarios in a pool or shallow water up to a maximum of five meters are conceivable.lve. If you have a separately shut-off first and second stage, as is common with cold-water systems, you can help yourself in this situation: put the second regulator in your mouth and close the valve of the faulty regulator yourself or have it closed, and reduce your depth.
© W. Pölzer – Sudden free-flow creates stress but is not so tragic if you act quickly, consistently, and with presence of mind.
2. Sudden panic or anxiety affects some divers out of the blue.
For others, such states build up beforehand. Signs of this can be an introverted demeanor or excessive talkativeness even before the dive. If you notice unusual characteristics in your buddy or yourself above water, address them in a private conversation.
If panic occurs underwater, the optimal course of action is always an individual decision. It is important not to put yourself in danger. Establishing proximity to your buddy, holding them loosely, physical contact, and reassuring eye contact help in many cases. Ascending to shallow water afterward also helps. However, there are also rare cases where divers shoot towards the surface in a complete panic. Attempting to restrain such a diver can be dangerous. Either the panicked diver inhales water into their lungs, or the rescuer ascends too quickly to the surface and becomes a problem themselves. In this case, it is better to keep an eye on the panicked diver but follow them at the emergency ascent rate of 18 meters per minute without a safety stop and ensure buoyancy and call for help at the surface.
First aid courses, where you practice such scenarios, for example, which grips to use or how to approach a panicked person, are offered by all training organizations. These Stress and Rescue courses are important foundations for all advanced diving courses. They are fun, make sense, and should definitely be taken by as many divers as possible.
3. Cardiovascular problems are, unfortunately, relatively common in diving.
According to the renowned Australian researcher Peter Buzzacott, they are the second most frequent cause of diving accidents in North America. A regular diving fitness examination can somewhat reduce this risk but cannot completely eliminate it, as the stress during an ECG does not correspond to the stress in the water. Also, a short ECG (whether at rest or under stress) is only a very small snapshot in time. A healthy lifestyle is the most important, although not always the easiest, form of prevention here. You should pay attention to your well-being on the day of the dive. Even if it’s a dive you’ve flown around the world for: if you feel unwell, don’t go diving! If you experience severe dizziness or even a stabbing pain in your chest or a numb left arm underwater, signal this to your buddy and immediately end the dive.
Accident Management: The Chain of Rescue in Diving
An emergency does not end with surfacing – the correct chain of rescue can decide between life and health.
First, initial measures must be taken at the scene of the accident. The injured person is rescued from the water with the help of assistants if necessary. At the surface, buoyancy should be established immediately by inflating the BCD or using an alternative buoyancy aid. The airways must be secured and breathing checked. If the diver is unconscious but still breathing, they are kept stable while floating on their back. The goal must be to get the injured person to shore as quickly as possible. If oxygen is available, it should be administered immediately. To prevent shock, it is important to keep the injured person warm, calm them down, and provide continuous care.
At the same time, an emergency call must be made. In Europe, dial 112; in other countries, use the respective local emergency number. It is essential to immediately contact a diving doctor or a recompression chamber, for example, via Aquamed, Divers Alert Network (DAN), the emergency hotline of the Verband Deutscher Sporttaucher (VDST) [German Sport Divers Association], or local rescue services. The circumstances of the accident must be described as precisely as possible, including the dive depth, the duration of the dive, the symptoms that occurred, and the measures already taken.
In the next step, transport is organized. If the injured person’s condition requires it, they should be transported lying down. If recompression chamber treatment is necessary, it must be ensured that transport is direct to avoid wasting valuable time.
When handing over to medical professionals, it is crucial to provide all relevant information. If available, the injured person’s dive computer should be handed over, as it can provide valuable data about the course of the accident. In addition, the progression of symptoms, the duration and amount of oxygen administered, and the injured person’s reaction to the first aid measures must be documented and passed on.
After the acute emergency, thorough follow-up care should be provided. All those involved should reflect on the event to learn from it and prevent future accidents. If necessary, the injured person should undergo a medical follow-up examination to rule out any long-term effects. It is also advisable to officially report the incident, for example, to dive schools, clubs, or insurance companies, to enable an analysis of the causes and possible improvements in emergency management.
Problems After Diving
If symptoms of decompression sickness (DCS) or other abnormalities occur after diving, even without any mistakes being made, such as joint pain, dizziness, nausea, or skin changes, pure oxygen should be administered immediately. Contact the dive center immediately in this case. Additionally, seek (tele)medical help immediately. Hotlines such as Aquamed, Divers Alert Network (DAN), or the emergency hotline of the Verband Deutscher Sporttaucher (VDST) can provide professional support. Here, too, documenting the emergency is important and can make things much easier for helpers afterward. The injured person’s dive computer should also be secured or its data read out. Times, what happened, when and where, and how much oxygen was given should be documented.
First Aid and Emergency Equipment
Attending a first aid course, especially for divers, should be in your own interest. Here, you will learn how to react in the event of accidents until professional help arrives. A well-equipped first aid kit and a functioning oxygen set should always be readily available. People trained in their use should also be present. You can refresh your knowledge in such a course every five years.
Accident Management in Remote Diving Areas
The Banda Islands in the Maluku region of Indonesia are a dreamlike diving area. Small disadvantage: the rescue routes are very long.
Diving emergencies are a challenge even in well-developed areas, but in remote regions – far from medical infrastructure – the complexity increases enormously. Here, proper preparation is essential to ensure the survival of the injured person in an emergency.
1. Initial Measures at the Scene of the Accident
The basic immediate measures remain the same as in any diving accident: the injured person must be secured, stabilized, and cared for. However, under difficult conditions, such as on a boat without rapid evacuation options or on a remote beach, additional challenges arise:
- Maximize oxygen administration: Since rapid transport is often not possible, long-term oxygen supply is crucial. Dive operators should always have a large O₂ system (e.g., 50-liter cylinder or more) or a Wenoll rebreather system available.
- Airway management and shock prevention: In case of unconsciousness, positioning the person on their back at the surface is advisable. On land, the injured person should be kept warm to prevent hypothermia.
- Long-term monitoring: In remote areas, it can take hours or even days for professional help to arrive. Therefore, continuous care is necessary.
2. Emergency Calls and Communication in Remote Areas
A mobile phone or normal radio connection is often insufficient. To call for help, divers should have the following options available:
- Satellite communication: A satellite phone (e.g., Iridium, Inmarsat) or a GPS emergency beacon (e.g., Garmin inReach) can save lives. These devices work independently of mobile networks and enable worldwide emergency calls.
- Emergency frequencies on marine radio: If a boat with VHF radio is nearby, a Mayday signal can be sent via Channel 16 (international distress frequency).
- Dive insurance with emergency service: Organizations such as DAN or Aquamed offer worldwide emergency services, can coordinate evacuations, and provide cost coverage declarations for expensive rescues and repatriation.
3. Transport Options in Remote Regions
Rapid transport to the nearest recompression chamber or clinic is often difficult. Here are possible options:
- Rescue by boat: If a fast boat is available, the injured person can be taken to the nearest medical facility or an airport.
- Air rescue: Many countries have private emergency helicopters (e.g., Flying Doctors in Africa, Rescue Services in Australia). A satellite emergency call can trigger such a rescue.
- Alternative transport routes: If evacuation is not possible, the patient must be kept stable and monitored until medical help arrives. In such cases, prolonged oxygen administration is often crucial.
In remote areas, air rescue is often the fastest option.
4. First Aid Under Extreme Conditions
Recompression chamber not reachable: If decompression sickness occurs but no recompression chamber is available, only symptomatic treatment remains. This includes:
- Oxygen administration for hours or days: Some people mistakenly believe that a diver breathing oxygen from a cylinder at the surface should occasionally take air breaks to prevent central nervous system (CNS) oxygen toxicity. Although this assumption is well-intentioned, according to DAN, such breaks are unnecessary for O₂ breathing of up to 12 hours. Oxygen should be administered continuously. While air breaks are occasionally taken in the recompression chamber to minimize the risk of CNS toxicity, this is only necessary for divers being treated at the surface after a very long O₂ administration of 12 hours or more to avoid irritation of the lung tissue.
- Drinking plenty of fluids (no alcoholic beverages or coffee) is important.
- Lying flat to avoid circulatory problems.
- Avoiding exertion to prevent worsening.
- Unconsciousness: If the injured person is not breathing, CPR (cardiopulmonary resuscitation) must be performed immediately. If a defibrillator is available, it should be used.
- Severe injuries: In case of bleeding wounds, infection prophylaxis must be observed, as tropical areas often have a high risk of wound infections.
5. Prevention is the Best Protection
Since rescue chains in remote regions are often unreliable, prevention is the most important factor:
- Strict dive planning: Conservative dive plan with safety margins.
- Redundant equipment: Additional regulators, spare oxygen cylinders, communication devices.
- Basic medical training: Optimal, but unfortunately not very realistic: every diver in remote areas should have completed an advanced first aid course (e.g., “Remote First Aid”). At the very least, the responsible personnel should have such training.
- Establish an emergency plan beforehand: Even before diving, it must be clear what evacuation options exist and where the nearest recompression chamber is located.
The best option depends slightly on the context, but all of these are accurate and well-phrased. The first option is probably the most straightforward and generally applicable.
Conclusion
Diving emergencies are rare. But good preparation and knowing how to act in critical situations can save lives. A relevant diving course and regular training underwater and above water provide safety… What about your rescue skills?
Regular training is also useful and helpful for experienced divers.
