— Post Traumatic Stress Disorder in Recreational Dive Rescuers
We are taught how to rescue other divers in emergency, but who prepares us for the aftermath and effects of witnessing a tragic event up close? Rescue attemtps do not always end well, and even when they do, Post Traumatic Stress Disorder (PTSD) is a very real possibility for those who have just been involved with a life or death situation in a recreational dive setting.
On a dive boat everything is going well and all are having a good time. Suddenly a shout for help is heard from the port side. Looking over, a pair of divers is seen and one appears to be unconscious. Two members of the party dive in and assist the buddy in getting the stricken diver to the swim platform. Stripping the gear from the diver takes but a few seconds. Getting them into the boat takes a little less than a minute more.
Once on the boat, it is soon determined that the diver is not breathing and has no pulse. CPR is started and after a couple of minutes a pulse is found. The team begins to relax when suddenly the diver convulses, begins spewing a bloody froth, and collapses. The diver does not regain consciousness. Shortly after, those divers who were directly involved in the rescue begin to have problems. One has nightmares and cannot get the deceased diver’s face out of his mind. Another suddenly begins selling off his gear and no longer returns calls from anyone associated with scuba. The diver who was the actual buddy of the victim is killed in a car accident while driving drunk. Prior to the event, he had never been known to over indulge in alcohol.
A dive outing at a local quarry and a group of Open Water students are enjoying their checkout dives. At the end of dive number two, a student diver surfaces saying she’s lost her buddy and he has not surfaced. While quickly scanning the surface for bubbles, the instructor and divemaster get all the students to shore and sound an alarm. Those on shore take action by notifying the quarry owner, calling emergency medical services (EMS), and gathering information from other divers coming out of the water.
The instructor and his assistant search in the last reported area the diver was seen. It is near an underwater platform used for training. They spot a fin tip sticking out from around the corner or the platform. It is the missing diver—a 60 year old man, eyes wide open, and with his regulator out of his mouth. They bring him to the surface and begin with in water rescue breathing followed by CPR once they reach shore but it is too late. The diver never regains a pulse and is taken away by EMS personnel.
During these events, the man’s buddy—his wife—is hysterical and begins screaming at the instructor and his assistant demanding to know why they were not watching them and did not know where they were. Why were they so far ahead of the class and did not know her husband had gotten separated from the rest? An autopsy will show that the man suffered a massive heart attack from a previously unknown condition. Yet the assistant cannot get the man’s face out of his mind—underwater, no regulator, eyes open, but lifeless and staring straight ahead. Mixed with that is the woman’s accusing voice that haunts him.
He has difficulty sleeping, withdraws from his friends, and though he still dives, he no longer will assist with classes. The instructor suddenly cancels all classes and ignores his other students’ calls and emails. He is cleared of criminal wrongdoing but receives a reprimand from his agency for not being in control of his students and not adhering to standards. Soon he drifts out of the local dive scene and moves away with no forwarding address. He has difficulty sleeping, withdraws from his friends, and though he still dives, he no longer will assist with classes... Soon he drifts out of the local dive scene and moves away with no forwarding address.
It’s a warm sunny day and a group of friends are having a good time at a local lake. One member of the group had previously been involved in the rescue of a diver a couple months earlier that did not turn out well. Yet until this time, he had not been suffering from any after effects of that incident. Suddenly one of his friends suffers a severe leg cramp and yells for help. Others rush to his aid and pull him from the water. He suffers no serious injury and soon recovers with some stretching and massage of the leg muscles.
Another diver looks at the one who had been in involved in the previous rescue and asks why he did not respond as he was so close. The diver says nothing and turns away from the group, packs up his gear, and speeds from the site.
A few days later he brings his gear to the local shop and asks them to sell it. He refuses to take calls, does not answer emails, and is heard to be having problems at his job. Yet he will talk to no one and is about to be fired when his boss sends him to an employee intervention program. Here he discovers that his first rescue experience that did not turn out well caused him to not respond to a rather simple need for assistance. The guilt he felt over that as well as subconsciously feeling he could have done more in the first scenario and perhaps changed it to a more favorable outcome turned into something serious that affected his entire life. With the help of a trained professional he was able to come to terms with these events, but he never dived again.
During a series of open water dives, an individual in group of divers using rental gear suddenly has a regulator begin to free flow towards the end of the dive, which quickly empties his tank of his remaining air. The diver signals an OOA to his buddy and the buddy donates his octopus.
As the diver with the free flow takes the octopus, the cover falls off, and he is left holding an octopus that does not work. He heads for the surface while continuously exhaling. His buddy follows and soon surfaces beside him. He is congratulated for executing a successful self-rescue. The buddy apologizes profusely and is told that it really wasn’t his fault but that of the crappy rental gear. They laugh it off and decide to end the diving for the day and both seem fine.
That night, the diver whose regulator fell apart catches himself analyzing the incident until he realizes that he is up much later than he should be. He sleeps fitfully and has rough day at work. It happens again two days later. The diver with the free flow finds that on the next dive outing that he spends much of the first dive tense and preoccupied with his air supply, to the extent that he loses track of his buddy and has to swim hard to catch him. The next dive is not much better. He enjoys neither of the dives. The next weekend he begs off one of the days and soon finds that he is not interested in going at all.
A very real possibility
These four scenarios are fictitious and are not taken from any one actual event. All of them are used to illustrate the effects that Simple Post Traumatic Stress Disorder or Simple PTSD may have on a diver who rescues another.The idea for adding this topic to the Scuba Educators International (SEI) Diver Rescue and Accident Management (DRAM) course is the result of having been involved in a few rescues of recreational divers. It is also a result of speaking with other divers who were able to be of assistance to one of their own. Finally it is from reading the reactions of divers to events that did not turn out well and the effect the incident had on them.
Not all rescues will have positive outcomes. Even those that do may have effects that the rescuers may not see coming. Those effects may present themselves to varying degrees over different lengths of time. They may not have much effect on the rescuer. When they do though, they need to be addressed and dealt with. Post Traumatic Stress Disorder, or PTSD, is a very real possibility for those who have just been involved with a life or death situation in a recreational dive setting.
Scuba diving is an activity that for many people is filled with adventure, knowledge and enjoyment. It is an activity that is safe as long as one follows his or her training and experience. Pushing those limits too far, too fast can, however, result in an accident that ...
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