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Home My WebLink AboutWRT Dive Operations Guide Fresno Fire Department April 2020 Page 1 Fresno Fire Department WRT Dive Operations Guide Fresno Fire Department April 2020 Page 2 Table of Contents PURPOSE ....................................................................................................................... 3 APPLICATION ................................................................................................................ 3 OPERATIONAL POLICY ................................................................................................. 4 Risk Management Overview ........................................................................................ 4 Risk Management Planning and Diver Operations Safety ........................................... 4 Hydrology for Dive Operations ..................................................................................... 9 General Safety Practices ........................................................................................... 13 Safety Practices Unique to Swift Water...................................................................... 14 Tending and Rope Systems for Swiftwater Diving ..................................................... 15 Diving from Small Boats ............................................................................................. 17 Safety Diver(s) ........................................................................................................... 21 Medical Monitoring of Safety Divers ........................................................................... 21 Safety Diver Tasking .................................................................................................. 21 Search Patterns ......................................................................................................... 22 Diver Entrapment ....................................................................................................... 28 Emergency Procedures for Diving-Related Accidents ............................................... 30 Dive Tables ................................................................................................................ 35 ACRONYM GLOSSARY ............................................................................................... 39 REFERENCES .............................................................................................................. 40 INDEX ........................................................................................................................... 41 Fresno Fire Department April 2020 Page 3 PURPOSE The purpose of this policy is to provide guidance to performing safe diving operations in the environments commonly encountered in the WRT response area . APPLICATION This policy is intended for Fresno Fire Dive Team members who have completed the course of training required to be a qualified diver. This manual assumes requisite knowledge obtained from the following completed courses or their equivalencies.  PADI or NAUI Basic and Advanced Open Water Diver  Swift water Rescue Technician Unit 1  Swift water Rescue Technician Advanced  Emergency Medical Technician Basic  Basic Rope Rescue or Rescue Systems 1  ICS 200,700,800 This policy also assumes a working knowledge of the following Fresno Fire Policies  SOP 201.001 Incident Command  SOP 201.014 Urban Search and Rescue  SOP 202.014d Water Rescue  SOP 203.001 General Safety Guideline  Rapid Intervention Standard Operating Guideline Fresno Fire Department April 2020 Page 4 OPERATIONAL POLICY Risk Management Overview This manual recommends practices for experienced divers in order to safely conduct self-contained underwater breathing apparatus (known as scuba) diving operations in currents in excess of 1 knot and surface supplied diving (SSD) in excess of 2.5 knots . Supervisors and Incident Commanders must emphasize that swift/fast water diving operations are inherently more dangerous and pose additional risks to the diver and support personnel beyond those encountered in normal diving operations . There are several controls that must be applied to provide barriers to risk in dive rescue operations. The Dive Group Supervisor should consider the experience levels of the primary and safety diver. It is generally recommended that the more experienced diver should be assigned as safety in order to achieve the highest l evel of safety for the primary diver. In addition, personnel from the Rescue Alarm Assignment that may be utilized, who are not divers, may be incorporated into position that apply additional risk control measures including:  Dive Tenders. (If properly trained and briefed, the supervisor may elect to use non-dive qualified personnel).  Upstream Spotter.  Downstream Safety (consider multiple based upon risk profile).  Medic Standby.  Safety Officer.  Interagency Liaison. In addition to personnel, the Dive Group Supervisor should also thoroughly assess the dive site for hazards that may be considered too dangerou s for diving operations or hazards that may be dangerous but can be mitigated with control measures and control measures implemented prior to the dive . More detailed information regarding risk assessment is provided later in this manual. If the Dive Group Supervisor or Divers are uncomfortable with any dive based upon conditions or experience level the dive SHALL not be performed. Risk Management Planning and Diver Operations Safety Fresno Fire Department April 2020 Page 5 a. Minimum Staffing Minimum staffing for swift/fast water diving should be increased whenever tactically possible. Neither the techniques listed in this manual, nor the conditions encountered at the diving location, preclude the leadership, or diving supervisor, from ensuring that all diving operations are conducted in a safe manner . At a minimum, the following positions should be identified and filled. SCUBA Diving  One diving group supervisor (DGS)  One dive recorder / tender supervisor  One diver. Diving in buddy teams is not recommended  One standby/safety diver  Two tenders. If properly briefed, the supervisor may elect to use non -dive qualified personnel  One upstream spotter  One downstream safety (more may be utilized depending on DGS discretion)  Ambulance standby ready for immediate use Surface Supplied Diving  One diving supervisor  One diver. Diving in buddy teams is not recommended  One standby/safety diver  One air console operator/communications  Two tenders. If properly briefed, the supervisor may elect to use non-dive qualified personnel  One upstream spotter Fresno Fire Department April 2020 Page 6  One downstream safety (more may be utilized depending on DGS discretion)  Ambulance standby ready for immediate use b. Single Divers Single divers are recommended for all swift/fast water diving operations to avoid fouling or entrapment due to additional lines in the water. SSD, particularly the Kirby Morgan BandMasks, are preferred over standard regulators to reduce the risk of accidental loss of the air source due to increased current. c. Downstream Safety for Divers Downstream safeties should be positioned at an appropriate location, based on current velocity and navigational obstacles, which allows for the most safe and expedient recovery of a displaced diver or swimmer . Shore-based downstream safeties shall have a throw bag with enough line to reach a victim washed from the dive site. For example, a diver located 75 feet from the near shore would require a shore-based downstream safety to have at least 75 feet of line in his throw bag . This will allow the safety to rescue a diver who is washed downstream and unable to swim towards the shore. If a shore-based safety is not feasible, personnel, in a motorized propeller less (jet) boat, should be positioned downstream. d. Risk Assessment An assessment of the site must be made by the DGS . A risk assessment includes identify hazards, develop controls and implement control. Hazards to be considered for a dive in swiftwater are:  Poor line management. An unmanned line in swift or fast moving water can quickly become an entanglement haza rd to divers in the water as well as personnel on the surface. It takes focused effort, practice, and skill to avoid getting entangled in a whipping line and pulled into the water.  Entrapment. Any passage that water flows through, but a diver cannot cleanly swim through poses significant risk. For example, sieves, undercut rocks, man-made debris.  Pinning. Water has the ability to press boats and bodies against an obstruction with enough force to hold them there . For example, strainers, broach pin, center pin, and end-to-end pin. Fresno Fire Department April 2020 Page 7  Physical hazards. Turbulent water can throw boats and bodies around. Divers should remain alert and be careful to avoid hazards such as hazards as hydraulics, breaking waves, crashing waves, and extreme helical flow. Moving water alone can cause rapid and uncontrolled downstream movement capable of fatiguing and drowning a diver even if they are not fully submerged. This is known as a flush drowning. Keeping the above considerations in mind, the DGS then formulates a risk assessment through a simple three step process of identifying hazards, developing controls and implementing controls. Considerations for all three are as follows:  Identify Possible Hazards First, identify the major events that are expected to occur during the operation and the hazards associated with all specified and implied tasks . The following are a few of the hazards associated with this type of operation:  Drowning  Arterial Gas Embolism  Entanglement/trapping  Tending difficulty  Tending line injuries  Exhaustion  Pollution/raw sewage  Floating debris  Razor wire  Pulmonary Over inflation Syndrome (lung expansion)  Lost diver  Strainers  Foot entrapments Fresno Fire Department April 2020 Page 8  Low head dams  Delta-P  Confined Space  Hydrology  Develop Controls Consider the following when determining what controls should be emplaced:  Velocity of the water  Suspected location of victim  Equipment on hand/logistics (harness, rigging, throw bags, and so forth)  Control of the rivers flow  Urgency of the dive (recovery versus rescue)  Training and experience of the team members  Risk vs. Benefit ratio.  Use of natural hydrology  Implement Controls Once the assessments and controls have been identified, the supervisor must implement them by:  Choosing equipment appropriate for the dive and incident .  Selecting personnel that are properly trained and experienced.  Conducting a pre-dive briefing.  Utilizing and Incident Action Plan.  Not accepting unnecessary risks. Fresno Fire Department April 2020 Page 9 Hydrology for Dive Operations Hydrology is the study of the movement, distribution, and quality of water . Swift/fast water operations require a thorough understanding of the hydrological forces at work on the surface and on the bottom to ensure divers can operate safely . When performing a risk assessment, visually inspect the dive site both upstream and downs tream. Watch the flow of the river around bends and turns, look for dead spots and eddies, take velocity measurements if time permits, and evaluate the terrain for access to downstream areas to serve as secondary recovery locations . Note: Consider using debris such as sticks, float buoys, and submersible mannequins to determine the rivers behavior. Also consider conducting a quick inspection dive along the riverbanks to determine potential hazards caused by roots, rocks, and debris in the area during casualty evacuation. a. Estimating River Speed A simple method for estimating river speed is the hasty method . The hasty method uses a floating object and a known distance . Place the floating object in the water at point a, and record the time it takes for that object to travel to point b. The current is equal to the distance divided by the time in seconds. CAUTION The river/canal you were on yesterday is different than the river/canal you are on today. Rivers/canals are prone to changing their behavior at any moment and measurements, emergency plans, and dive plans must be evaluated each day during the operation Fresno Fire Department April 2020 Page 10 b. Laminar Flow Water moves in layers. Each layer can be thought of as riding atop one another. This occurrence allows each layer to move faster than the one beside it as it is insulated from drag. Layers of moving water are slower on the bottom and at the banks; moving water is faster toward midstream and on the outside of bends. Man- made canals with smooth surfaces do not have pronounced laminar velocity differences. Water WILL be moving rapidly at the shoreline and on the bottom. Fresno Fire Department April 2020 Page 11 c. Helical Flow Helical flows occur when two laminar flows move in the opposite directions, interact, and create a whirlpool. d. Turbulent Flow Turbulent flow is the opposite of laminar flow. When water encounters an obstruction, the layers of flow twist and turn against one another. Unlike helical flow, turbulent flow is not uniform or predictable. For example, the foam pile of a hydraulic in the graphic below it would be safest for the diver to enter the water at the bank on the river’s left and follow the bottom contour to the center of the river . Fresno Fire Department April 2020 Page 12 e. Pillows Pillows are the swelling on the surface caused by an obstruction . The obstruction is usually just beneath the surface or may break the surface in which case the pillow will be in front of the object rather than above and in front . In deeper water, pillows may not be visible on the surface, but will exist underwater as the diver approaches the obstruction. This will tend to push a diver off the project. f. Hydraulics/Holes Hydraulics/holes are water that drops vertically over an obstruction. The larger the drop, the more defined the hole. A hole creates a back cu rrent where water is trapped behind an obstruction. Divers should take care to avoid becoming trapped in a hole. Large, white water holes can even swamp rescue boats. Hydraulics Fresno Fire Department April 2020 Page 13 impedes the downstream flow and can create a useful workspace for divers un der the right conditions. g. Strainers and Sieve Sieves and strainers are technically different methods to produce the same hazard. Water moving through either wood (strainer) or rock (sieve) via spaces smaller than a diver is a serious hazard. While water flows relatively unhindered through small spaces, large solid objects (such as divers and equipment) can be pinned to the object and trapped in the same manner as a Delta-P hazard. General Safety Practices a. In any swift/fast water diving scenario, the most important safety factor is experienced personnel. Every opportunity should be taken to conduct training dives, or specialized swift/fast water training, prior to an incident. If trained and experienced personnel are unavailable, the diving supervisors should carefully weigh the benefits of conducting the dive against the risk to personnel. b. In any new environment that is tactically permissive, a full walk through of the emergency action plan and incident action plan shall be conducted . If conducting CAUTION Hydraulics can be an extremely powerful river feature. They can trap divers, swamp rescue boats, and other small vessels. Fresno Fire Department April 2020 Page 14 swift/fast water operations at multiple locations with different evacuation routes, test the plan at each location. c. In order to increase the diver’s ability to control position, diving in swiftwater requires heavy weighting typically 2-3 times the normal weight of a standard diver. It is imperative that the diver know how to release weights in the event of an emergency . When diving in static water normal weights shall be used which is normal 10-15% of a diver’s own weight as a guideline d. The diver should be properly harnessed to the tending line . When possible avoid the use of a tending line tied around the diver’s waist. This will place the fulcrum in the wrong location and may cause injury to the diver in strong currents. A forklift safety harness can be used with slight modification to provide a diver tending line harness by moving the D-ring attachment point from the center of the back to the center of the chest. Other field expedient options are also available, such as running the tending line through the chest strap of a buoyancy compensator after being tied to the waist and thereby placing the fulcrum point higher. e. When swimming in currents, use the current to push you into place by swimmi ng at a steep approach angle. This will minimize downstream movement and allow the diver or swimmer to move perpendicular to the current. It is generally preferred that Fresno Fire Divers approach from downstream moving upstream . This allows the diver to ensure a clear escape route behind them in the event of being swept away. Safety Practices Unique to Swift Water a. Tending the diver at the chest is recommended to avoid pitching the diver head up and risking an arterial gas embolism. The tending line shall not be permanently attached (must use a quick release) in fast water as the chance of entrapment is Fresno Fire Department April 2020 Page 15 high. In fast water the ability to pull a diver who is trapped back upstream is limited and dangerous. All fast water dive emergency procedures should include the releasing of the tending line and defensive swimming to the downstream safety. b. However, emergency planning should include procedures for pulling the diver into the boat or to shore from the work site. c. In most instances, the diver can either be tended from a small boat or from the shoreline at an angle appropriate to the current. While a diver cannot typically swim against the current, they are usually able to navigate perpendicul ar to the current. d. Plastic, neutrally buoyant helmets can be worn to protect the divers head in the event flotsam or other objects impact the diver. Objects and tools should be minimized. The use of special tools like creepers, rebar spikes or other t ools may help the diver navigate. All objects should be secured to the diver. Tending and Rope Systems for Swiftwater Diving a. Rigging High Lines Rigging high lines (Tyrolean) for use as an attachment and tending point for divers are ineffective in most cases in wide rivers. The weight of the diver will cause the line to bow heavily and may prevent retrieving the diver . Using a 90-degree or lower angle increases the mechanical advantage and should be used in fast water. If tending from a boat, a belay may need to back up the primary tender, and the boat should be tended by multiple lines at angles not to exceed 45 degrees (90 degrees total) from the direction of the current. b. Highline rigging from shore. High lines were designed as an answer to vertical rescue problems . Under those circumstances, with easily estimated or even known forces, high line techniques are Fresno Fire Department April 2020 Page 16 invaluable tools. For swift/fast water applications where immense and varying drag is generated by lowered boats and divers, high lines become difficult to manage and are ineffective. Alternatively, proper use of a multipoint tethered boat lower system can offer the same traversing abilities as the high line system. Additionally, the multi-point tethered boat lower system uses less equipment and provides a more stable workspace. c. Tension Diagonals (Zip Lines) Tension diagonal uses the rivers current to move the diver downstream and across the river from nearshore to far shore. The zip line takes less time to set up than the high line system and can be used in faster currents . Both sides of the river should be secure. Place a transverse line at about a 45 -degree angle from the flow of current. The diver will move from the upstream side to the downstream side letting the current push them. Tenders must be placed on the nearshore and the far shore to move the diver or boat both directions. Once the diver has moved to the far shore, the nearshore tender will place the line downstream and allow the diver to move back. The search pattern will then be shaped in a /\/\/\/\ fashion. Ensure that the movement of the downstream tender is not so great as to miss large areas . For working dives, simply drop the diver down the zip line to the project site and hold . The far shore tender can also place a small line at the end of the zip line in order to add a vector pull. Fresno Fire Department April 2020 Page 17 Diving from Small Boats When it is not practical to dive a diver from the shore, small boats can be used to provide a mobile dive side on the river. In slower currents an anchor can be used while in faster currents a high line may be used. Use of the motor should be limited only to establishing lines across the river and as a safety in the event of a line blowout. It is extremely taxing and risky to tend a diver from a boat under use of the motor as a stable platform. The graphics below present options available for use of a boat as a diving platform. Fresno Fire Department April 2020 Page 18 Fresno Fire Department April 2020 Page 19 Fresno Fire Department April 2020 Page 20 Fresno Fire Department April 2020 Page 21 Safety Diver(s) Similar to IDLH firefighting operations and the use of 2 -out, no diver may enter the water without a Safety. If multiple divers are needed than multiple safeties must be provided for each diver. The Dive Group Supervisor may also consider the use of multiple Safeties for one diver at select locations based upon the risk profile and judgment of the Dive Group Supervisor and Diver. The Safety Diver is the most experienced and most skilled diver in an FFD Diving Operation. The sole focus of the safety diver is to recognize potential problems before they become distress problems for the primary diver. Much like 2-Out the Safety Diver, while in a position suited up ready to enter the water, is gathering situational awareness and intelligence on the dive environment and the primary diver’s position and breathing patterns. Any potential concerns by the Safety Diver should be immediately brought to the Dive Group Supervisors attention. Medical Monitoring of Safety Divers Safety divers in “standby” mode are in extreme danger of dehydration and possible heat stroke. Heat stress protocols that apply to firefighting operations may also apply to Safety Divers on standby. Provisions must be made to attend to the comfort of these divers during the pre-deployment phase. Insofar as possible, the safety diver(s) should be seated in the shade, near the water, with cooling provisions (i.e., empty bucket) and drinking water available. If personnel are available medical monitoring should be performed both on the primary diver and standby d iver including vital signs. This information should be recorded and monitored by the Dive Group Supervisor Safety Diver Tasking The following are general tasks that are performed by the Safety Diver  Shall be fully suited, placed at the water‘s edge, and ready to respond except that the face mask or FFM can be held (as opposed to worn) and the hood can be pulled off the head.  Shall be in possession of a sharp knife (at least one), side cutters, tether line, and a safety clip.  Upon being deployed to assist an entrapped diver, the primary safety diver will attach the contingency line on the entrapped diver’s descending line and the other end to his/her harness. Care must be taken not to pull on the ent rapped diver’s down line, which could cause further injury or entrapment. Fresno Fire Department April 2020 Page 22  The primary safety diver is responsible for locating the entangled diver, determining the cause and location of the entanglement and freeing the entangled diver, if possible.  The primary safety diver should leave his/her contingency line affixed to the entrapped diver’s tether line and endeavor to work to free the entanglement while affixed to the line in order to avoid losing contact with the entrapped diver.  In the event it is necessary or desirable for the primary safety diver to disconnect from the contingency line in order to endeavor to free an entanglement, he/she may do so, but must maintain physical contact with the entrapped diver at all times.  In the event the primary safety diver is unable to free the entanglement, he/she should advise the diving operations supervisor and await the arrival of a secondary safety diver. Upon the arrival of the secondary safety diver, the primary safety diver will ensure the entangled diver has a continuous air supply available and will remove the entangled diver’s equipment as necessary in order to facilitate escape from the entanglement.  The primary safety diver will then guide the entrapped diver on an ascent to the surface.  In the event the freeing of the entangled diver should become a lengthy endeavor, the primary safety diver must be cognizant of the rescued diver’s bottom time and ensure decompression procedures are followed according to the rescued diver’s computer or dive tables. Search Patterns Search patterns are primarily utilized when currents are less than 1 knot and will allow for multiple divers to repeat a search pattern without the risk of being swept away by current. The use of a search patterns versus swiftwater line tending sweeps is at the discretion of the DGS and divers. A variety of search patterns may be utilized by the dive team. Fresno Fire utilizes rope pull signals developed by the Dive Rescue International and are commonly used throughout public safety dive teams . The following graphics depicts search pattern options: Fresno Fire Department April 2020 Page 23 Fresno Fire Department April 2020 Page 24 Fresno Fire Department April 2020 Page 25 Fresno Fire Department April 2020 Page 26 Fresno Fire Department April 2020 Page 27 Fresno Fire Department April 2020 Page 28 Diver Entrapment Underwater entrapment is unquestionably the most dangerous and frightening condition presented to the public safety diver. Entrapments can easily occur when ropes are utilized for search patterns and tethering of divers. Entrapment can result from entanglement as a result of being caught up in a myriad of underwater hazards (i.e., fishing line, wire, tree branches, tether line[s], etc.); from inability to reach the surface due to an overhead environment; as a result of being caught in a constriction; or from being held in position against a siphon or drain pipe, etc., by current . The problems associated with underwater entrapment are intensified by loss of visibility due to “silt - out” within the diving environment. Regardless of the circumstances that cause the entrapment, unless the diver is able to either escape the entrapment on his own accord or be assisted in escape by another diver, the result is invariably the same -- either panic by the diver resulting in his/her spitting out his regulator, swallowing water and drowning, or an eventual depletion of air supply followed by drowning. Fortunately, most of our entrapment situations amount to entanglements (sometimes referred to as line entrapments). Entanglements can be dangerous, although more often than not are merely annoying. It is not out of the realm of possibility for an entanglement to distract a diver and in his effort to free himself/herself lead to other, more serious problems. To prevent the injury/death of dive personnel encountering an entrapment situation, the following procedures are to be followed:  The Entangled Diver  Each diver will be deployed with the following equipment: o Either an umbilical line or tether (search line) attached to the dive tender at one end; and clipped to the diver’s BCD or harness at the other o Sharp knife (at least one) and side cutters or trauma shears o Full face mask with underwater communication device or use of tether line for rope pull signals o Pony bottle (minimum 13 cubic ft.) as a temporary emergency air supply  Upon encountering an entanglement, the diver will: Fresno Fire Department April 2020 Page 29  Stop and think about where he/she is hung up and what might be causing the entanglement  Endeavor to determine (by feel) the location and cause of the entanglement  Endeavor to free himself/herself and/or equipment from the entanglement  Should the diver be unable to free the entanglement, he/she will:  Advise the topside communication operator he/she has an entanglement emergency.  If radio communications are not possible, the diver will use rope signals, which will consist of four pulls on the rope tether.  Remain as still as possible in order to conserve air and facilitate the best possible visibility for responding safety diver(s).  If the primary air source is depleted, advise the topside communications operator that he/she is switching to emergency air, activate the valve on the pony bottle, and breathe from the redundant second-stage regulator.  Equipment necessary for diver rescue from entrapment:  An orange webbing contingency strap to be affixed to the searching diver’s tether line by the safety diver affecting the rescue in order to assist in hands-free location and disentanglement of the entrapped diver. o The contingency line should consist of two carabiners fastened together by a length of 1-inch nylon webbing approximately 24 inches long. o One of the carabiners on the contingency line is attached to the safety diver’s harness or BCD -- the other to the entrapped diver’s tether line. o Sharp knife and side cutters. o Buddy line. o Safety cylinder/SCUBA RIC bottle. Fresno Fire Department April 2020 Page 30 o Minimum 80 cubic ft. aluminum or 66 cubic ft. steel with first and second stage regulator attached, and stage bottle strap affixed. o Additional air cylinders/regulators of varying capacities can be shuttled to the secondary safety diver by supplementary dive personnel as necessary. Emergency Procedures for Diving-Related Accidents All dive operations will have an Ambulance on standb y. The DGS will have a medical plan as a part of his Incident Action Plan and Risk Management Options . Specialized consultation is available through the Divers Alert Network (DAN) (919) 684 -8111. Helicopter evacuations can be requested through normal dispatch procedures by the incident commander. Oxygen should be an absolute necessity on every dive . Oxygen is the one first aid treatment that can be used with the full knowledge that it can only help and usually is the one treatment that will turn a serious diving injury around . It is the first thing you should think of in all serious decompression illness and should be used even if you're uncertain of its need. a. Diving Accidents requiring immediate transportation to a Chamber Facility Air Embolism Recognition (This usually occurs during or immediately after surfacing) Symptoms (one or more of the following)  Disorientation  Chest pain  Paralysis or weakness  Dizziness  Blurred vision  Personality change  Voice change in tonal quality (mediastinal air) Air Embolism Signs (one or more of the following) Fresno Fire Department April 2020 Page 31  Bloody froth from nose or mouth  Paralysis or weakness  Unconsciousness  Convulsions  Stopped breathing Air Embolism Management  CPR, if required  Open airway, prevent aspiration, intubate if trained person available  Give O2, remove only to open airway or if convulsions ensue.  Mask, if available  If conscious, give nonalcoholic liquids  Place in horizontal, neutral position  Restrain convulsing person loosely and resume O2 as soon as airway is open  Protect from excessive cold, heat, water or fumes  Air evacuation should be at sea level pressure or as low as possible in unpressurized Aircraft  Contact hyperbaric chamber, send diver's profile with the diver, and send all diving equipment for examination or have it examined locally. Transport to nearest emergency facility closely associated with a recompression chamber. Do not waste time evaluating and stabilizing at a facility unaccustomed to diving emergencies. This is possibly the most important thing you can do! Call DAN at 919-684-8111 in the USA Fresno Fire Department April 2020 Page 32 Decompression Sickness Recognition (Symptoms usually appear 15 minutes to 12 hours after surfacing) Signs  Blotchy rash  Paralysis or weakness anywhere in the body  Coughing spasms  Staggering or instability  Unconsciousness Personality change Symptoms  Tired feeling  Itching  Pain, arms, legs or trunk  Dizziness  Numbness, tingling or paralysis  Chest compression or shortness of breath  Anything unusual after the dive Early Management  Stabilize patient the same way as for Air Embolism  Urgent recompression after stabilization in trauma facility closely associated with a recompression chamber  Immediate oxygen breathing, continue even if person improves markedly  Mask, (if available) Fresno Fire Department April 2020 Page 33  Early recompression treatment for all forms of decompression sickness b. Diving Accidents requiring immediate transportation to the closest facility Pneumothorax Symptoms  Pain in the chest  Shortness of breath Signs  Shallow, rapid breathing  Cyanosis (blue skin, lips, fingernails)  Possible crackling under the skin of the neck  Possible mediastinal shift (Heart sounds not in the usual place) Treatment  No recompression necessary, if there is no arterial gas embolism associated  A physician needs to insert a chest tube, withdraw air so that the lung can re- inflate  If recompression therapy is required because of AGE or DCS, a chest tube is a must to prevent "Tension pneumothorax" Mediastinal Emphysema (Lung over pressure accident) Decompression Sickness is preventable! It occurs when a diver has exceeded his/her nitrogen absorption time from breathing compressed gas. The DGS is responsible for creating a strict dive profile (time and depth limits) prior to the dive and ensuring adherence to the profile. Plan the dive and dive the plan! Fresno Fire Department April 2020 Page 34 Recognition (Always associated with pneumothorax) Symptoms  Pain in the chest (beneath the breastbone)  Faintness  Shortness of breath Signs  Obvious difficulty breathing  Brassy change in voice Treatment  O2  Should be seen by physician and observed for 24 hours  No chamber recompression needed unless associated with air embolism or DCS c. Diving First Aid for injuries that do not usually require an immediate transport but may need Physician evaluation. Nitrogen Narcosis Signs  Inappropriate behavior at depth  Ignoring hand signals and instructions  Stupor or coma Symptoms Fresno Fire Department April 2020 Page 35  Inflexible mentation (thinking)  Decrease or loss of judgment  False sense of security  Lack of concern for safety  Inability to think through problems  Panic  Near unconsciousness or loss of consciousness at depth Treatment  Ascend until free of symptoms  Surface with controlled ascent  Follow up with training Ear Disorders Ear injuries occur when improper diving techniques to clear the ears are not performed or when diving with a cold. The failure of a diver to clear his or her ears may result in barotrauma to the middle or inner ear and can include vertigo and dizziness. Suspected ear trauma must be seen by a Physician ENT Specialist and the affected diver may not dive until clearance is obtained by the Physician Dive Tables a. It is imperative that all divers track their bottom time and dive according to the plan set forth by the DGS. It is the DGS who sets the maximum time and depth limits for any dive operation. Most dives in the City of Fresno are shallow water dives in swiftwater with a maximum time of 20 minutes . Any deviation from this typical diving environment is considered hazardous and it is up to the DGS and dive team to make a collective decision based upon the risk assessment profile and experience of the divers to dive any depths beyond 1 atmosphere (33 feet). All members of the dive team will be proficient in use of the PADI or NAUI dive tables. Fresno Fire Department April 2020 Page 36 Fresno Fire Department April 2020 Page 37 Fresno Fire Department April 2020 Page 38 Fresno Fire Department April 2020 Page 39 ACRONYM GLOSSARY DGS = Division Group Supervisor NAUI = National Association of Underwater Instructors PADI = Professional Association of Diving Instructors SOP = Standard Operating Procedure SSD = Supply Side Diver WRT = Water Rescue Team Fresno Fire Department April 2020 Page 40 REFERENCES  PADI Open Water Diver Manual, PADI  PADI Rescue Diver Manual, PADI  NAUI Open Water Diver Manual, NAUI  Dive Rescue International, Public Safety Search Pattern  Swiftwater Rescue Technician Unit-1 Manual  Public Safety Diving, Andrea Zaferes and Walt Hendrick  TM 3-34.84 Swift Water Diving Operations, U.S. Army, March 2015  Oconee Dive Team Operations Manual, Fresno Fire Department April 2020 Page 41 INDEX A Air Embolism · 29, 30 D Decompression Sickness · 30 Develop Controls · 8 Dive Tables · 34 Dive Tenders · 4 Diving Accidents · 29, 32 Diving from Small Boats · 16 Downstream Safety · 4, 6 E Ear Disorders · 34 Emergency Procedures · 29 Entangled Diver · 27 Entrapment · 6, 27 Estimating River Speed · 9 G General Safety Practices · 13 H Helical Flow · 10 Highline rigging from shore · 15 Hydraulics/Holes · 12 Hydrology for Dive Operations · 8 I Identify Possible Hazards · 7 Implement Controls · 8 Interagency Liaison · 4 L Laminar Flow · 10 M Mediastinal Emphysema · 32 Medic Standby · 4 Medical Monitoring of Safety Divers · 20 Minimum Staffing · 4 N Nitrogen Narcosis · 33 P Physical hazards · 6 Pillows · 11 Pinning · 6 Pneumothorax · 32 Poor line management · 6 R Risk Assessment · 6 Risk Management Overview · 4 Risk Management Planning and Diver Operations Safety · 4 S Safety Diver · 20 Safety Officer · 4 Safety Practices Unique to Swift Water · 14 SCUBA Diving · 5 Search Patterns · 21 Single Divers · 6 Strainers and Sieves · 13 Surface Supplied Diving · 5 Fresno Fire Department April 2020 Page 42 T Tending and Rope Systems for Swiftwater Diving · 14 Tension Diagonals (Zip Lines) · 15 U Upstream Spotter · 4