Microsoft word - ch 39 09.docx

Chapter 39
All chapters, full text, free download, available at http://www.divingmedicine.info FIRST – AID KIT

Certain drugs and equipment are of value in a diving accident and a diving team could
reasonably be expected to acquire and carry these on diving expeditions. Training in the use of
these, as well as in resuscitation, is of great importance.
FIRST-AID MATERIALS

For shark attack or trauma, large sized thick cotton pads (more than 20 cm square) with 10 cm
crepe bandages (6 of each) are useful to make pressure dressings to stop bleeding and also
for pressure bandages to reduce venom absorption. If obtainable, shell dressings of the type
used by the military are ideal for this purpose. They can sometimes be obtained from army
disposal stores.
A rubber bandage 10 cm wide ("esmarch" bandage obtainable from a medical equipment
supplier) for use as a tourniquet. When wrapped tightly around the limb this is the best form
of tourniquet. It covers a wide area, effectively stopping blood flow to the limb while
minimising damage to tissues under the tourniquet.
Small adhesive skin dressings such as Elastoplast or Band-Aids.
Surgical instruments — scissors, artery forceps, fine forceps, disposable scalpel blade,
disposable syringes and needles.
An aluminised thermal blanket such as a "Space blanket" to protect divers suffering from
hypothermia.
Heat packs — of value in treating fish and minor jellyfish stings (not box jellyfish).
Cold packs — of value in reducing pain with jelly fish sting and general muscular strains
Eye irrigation solution.

Torch, pen and paper (for recording purposes).
RESUSCITATION
EQUIPMENT


• Airways (Guedel type) in two adult sizes are useful if a victim loses consciousness and
develops airway obstruction, or if artificial respiration is needed. A positive pressure air system
(such as an AMBU Bag) is of value in combination with the airway, for prolonged artificial
respiration. As with all resuscitation techniques, training and practice is required
• Oxygen First Aid and Resuscitation Equipment. A supply of oxygen and equipment to
administer it can be lifesaving in some diving accidents. Devices as described in Chapter 40
should include a complete oxygen supply and delivery system in a robust portable container.
• A large oxygen cylinder with appropriate adaptors should be available if diving at a distance
from diving medical facilities and recompression chambers.
An underwater oxygen system (appendix C) for recompression therapy by more sophisticated
groups, in remote areas.
MEDICATIONS FOR
DIVING PROBLEMS


• Household vinegar, preferably a litre or more, to neutralise adherent stinging cells of box
jellyfish and some other tropical jellyfish. Household bleach is useful for sterilising coral cuts.
• Local anaesthetic spray or ointment (lignocaine) to relieve the pain from minor stings from
animals such as Portuguese man-o-war and other jellyfish stings. Solacaine or other anti-burn
preparations such as Tannic acid sprays may be efficacious for this purpose.
• Topical antibiotic powder to prevent infection from coral cuts and other minor injuries.
• Skin antiseptic solution such as chlorhexidine for cleaning wounds contaminated with dirt.
• Broad spectrum antibiotic tablets (e.g. erythromycine, doxycycline) to initiate treatment for
serious infections, otitis externa, otitis media, sinusitis, and coral cuts etc.
• Prophylactic ear drops such as commercial preparations of Aqua Ear, Vosol or Otic
Domoboro.

• Therapeutic ear drops, including antibiotic and steroid combination, for outer ear infections.

• Local anaesthetic for injection such as lignocaine 1% (without adrenalin) for wounds from
stone fish and other fish stings. Up to 15 ml of this solution can be injected into the stung area
in an adult and repeated every 2 hours if necessary.
• Antivenoms — depending on the geographical location.
GENERAL MEDICATIONS


• Anti-diarrhoea tablets such as diphenoxylate ("Lomotil") or loperamide ("Imodium").
• Analgesics (pain killers) such as paracetamol (acetaminophen). Aspirin, or drugs containing
this substance, may be unpredictable and hazardous and are best avoided.
• Ultra-violet blocking sunscreen (SP15+ or greater). A 1% hydrocortisone cream is useful
to treat sunburn, allergic dermatitis or itching.
• Anti-Seasickness tablets (see Chapter 32).
• Decongestants — pseudoephedrine tablets, and topical nasal sprays.
• Topical antibacterial and antifungal preparations, such as Cicatrin or Neosporin.
TRAINING


A diving team venturing to a remote locality should have at least one member (preferably two
in case that one becomes the victim of an accident) trained in first aid relevant to divers.
Resuscitation and oxygen administration requires expert training and supervision. Training in
the use of injections is an advantage, both for the administration of local anaesthetics,
antivenoms and other drugs under the direction and advice of a distant medical specialist.
MEDICAL INFORMATION


Perhaps the most valuable addition to any first aid box is a source of information. This should
include diving medical texts (see appendix A) and general contact numbers (see appendix B
& D) for both medical assistance and recompression chamber availability. This should be
supplemented by local contacts and phone numbers of knowledgeable divers and diving
physicians.
A copy of this book should remain with the First-aid kit.
Also in the kit should be a list of its contents, including purchase and
expiry dates of the drugs.
INFORMATION NEEDED
about a DIVING ACCIDENT.
CHECK LIST
Name of informant Name and age of victim TELEPHONE NUMBER to return call, or if disconnected Geographical location (+ local medical facilities or RCCs) Case history Initial symptoms, including time of onset Description of clinical symptoms + progress Signs of illness Negative findings (symptoms NOT present e.g. micturition, dyspnoea, skin wounds) First aid given (including oxygen, amount and method) Dive details: Profile, gases, deco,(+ recent dives) Personal history Any other persons injured First aid facilities and/or medical personnel available on site Follow up arrangements Medevac possibilities

Source: http://www.divingmedicine.info/Ch%2039%20SM10c.pdf