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    Oriskany Accident Managment Document

    Following is the document generated by a working group consisting of Coast Guard, Navy, local medical and hyperbarics professionals, local charter captains, and local diving indutry professionals. It details procedures for managing accidents on the Oriskany (however, many of the suggestions are applicable to any site- as is some of the information provided). It was a pleasure to work with the other members of the group, and very informative experience.

    Hope this helps to answer some of the many questions people have about the rescue and treatment capabilities of the Pensacola area.

    Heather


    Oriskany Dive Accident Management Plan
    10 January 2008


    Overview

    • Getting a dive accident victim with decompression sickness or arterial gas
    embolism to the hospital as quickly as possible is essential.
    • Begin first-aid oxygen as soon as possible on the dive boat.
    • Transport to shore on the diver’s own boat should be initiated as soon as
    possible.
    • Notify the Coast Guard of the accident on ship-to-shore radio Channel 16.
    • Request that the Coast Guard notify Escambia County (FL) 911 of the dive
    accident.
    • Transport the injured diver back to the Coast Guard Station Pensacola pier.
    • GPS Numbers for Coast Guard pier are:
    N 30-20-67
    W 087-17-40
    • Baptist Life Flight and Escambia EMS ambulance will both meet the dive boat at the Coast Guard pier.
    • The injured diver will then be transported to Baptist Hospital by the most expeditious method (typically Baptist Life Flight) for evaluation and treatment.


    Pre-Dive and Planning Considerations

    Recommended Diver Equipment
    Should include a signal sausage, a strobe light, a whistle, and a signal mirror in case the diver is separated from the boat upon surfacing and needs to signal it. A compressed-air activated signaling device may also be useful.

    Recommended Dive Boat Equipment/Training; (in addition to other standard equipment)
    • Emergency Oxygen - should have two-hour delivery capacity (120 cubic ft)
    - Diver’s Alert Network Dual Rescue Pak Extended care with MTV-100
    (approximately $825) which has two Jumbo-D cylinders (advertised 120 minute oxygen duration)
    or
    - Steel/aluminum scuba bottles filled with oxygen (and clearly marked
    as oxygen bottles) with oxygen-clean demand valve and regulator
    • Cell phone as backup to ship-to-shore radio
    • CPR training for dive boat Captain (and crew if possible)




    Communications
    • Ship-to-shore VHF-FM radio - Channel 16
    • All Coast Guard stations in the area monitor this channel (Panama City, Pensacola, Destin, Mobile)
    • Cell phones do not work from the Oriskany site

    Dive Planning/Briefing
    • Conduct a radio check to ensure ship-to-shore VHF radio is working.
    • Coast Guard requests that boats not do radio checks with Coast Guard stations.
    • Plan dives so that all divers reach the surface at approximately the same time insofar as possible.
    • No excursions below the flight deck of the Oriskany for non-technical divers.
    • If there is an accident, the dive boat will WAIT for all divers from that boat to be on board before transporting the injured diver back to shore.
    • If the Dive Boat Captain is diving, there should be a crew member who understands the Oriskany Dive Accident Management Plan and is licensed to operate the dive boat present on the surface at all times while the dive is being conducted.


    Dive Accident Management

    Who Has the Lead?
    • The Dive Boat Captain initially.
    • The Coast Guard acts as the Search and Rescue (SAR) mission coordinator and activates the Escambia County Emergency Medical System (EMS) when notified of a maritime emergency.
    • The Dive Boat Captain’s responsibility for his or her injured diver does not end when the Coast Guard vessel arrives on scene.
    • The Baptist Hospital Emergency Department physician has control once the injured diver has been transferred to an air or ground ambulance for transport to Baptist Hospital.













    First-Aid for the Injured Diver
    • If a diver surfaces with signs or symptoms of decompression sickness or arterial gas embolism, perform the steps listed below.
    • Remove the diver’s gear and have him or her lie down.
    • Ensure that the airway is open.
    • Start oxygen via demand valve or reservoir mask.
    • Patient Assessment: perform a rapid neurological exam - a detailed neurological exam is not required at this point.
    - If there are obvious signs/symptoms – not needed.
    - If signs/symptoms are subtle – Baptist will repeat anyway.
    • Monitor the injured diver closely for changes in status during the transport.
    • Secure the injured diver’s equipment for investigation. Do not tamper with equipment; the Coast Guard will take possession of the equipment for follow-up investigation as noted below.


    Recover All Divers from the Boat before Leaving the Dive Site
    • No immediate departure with another boat then picking up the rest of the divers from the injured diver’s boat.
    • Don’t plan on the injured diver going in with another boat that might be able to leave the site sooner: 1) all divers must be assured that their boat will be there for them on surfacing; 2) the Dive Boat Captain needs to maintain responsibility for his or her diver; and 3) transferring the diver to another boat would entail an unwanted transfer of liability for the injured diver to the receiving boat.


    Begin Transport Back to the Coast Guard Station Pier on Own Dive Boat ASAP
    • Do not stay at the dive site and wait for Coast Guard vessel to arrive.
    • Baptist Life Flight does not fly over the Gulf to do rescues at sea.
    • There is no transfer at sea to the Coast Guard vessel in the primary plan.
    - Time-consuming
    - May be hazardous to the casualty and individuals assisting.
    - May not be feasible at all if there are large swells.
    • A transfer of the injured diver at sea would typically be undertaken only if this would significantly reduce the transport time to Baptist Hospital and if the sea state allows.
    • If the injured diver is transferred at sea, be sure to transfer the first-aid oxygen and the person trained to administer it as well.
    • Docking at the Coast Guard pier – use the lower dock to the right of the larger pier.
    • The Coast Guard Station Pensacola pier has a helicopter landing pad nearby.
    • The Coast Guard will coordinate docking and movement of the injured diver from pier side to the helicopter landing pad.
    • The Coast Guard conducts an investigation into any diving accident that results in death or incapacitation for more than 72 hours. Do not tamper with the diving equipment; the diver’s equipment should be turned over to the Coast Guard at the pier and the name of the receiving person noted.


    Accident Notification – Emergency Medical Services Activation
    • The Coast Guard is the primary communications relay point.
    • Call Coast Guard Station Pensacola on Channel 16 VHF-FM radio.
    • Coast Guard stations at Mobile and Panama City may respond to calls for
    “Coast Guard.” Be sure to hail “Coast Guard Station Pensacola” when calling.
    • The Coast Guard Station Pensacola watch will:
    1) Call Escambia County (FL) 911 and notify them of a dive
    accident.
    2) Call the Naval Air Station Pensacola duty numbers.
    Command Duty Officer Cell Phone (850-418-5175)
    Commanding Officer (850-452-2713) (during duty hours)
    3) Ensure that the Coast Guard Station access gate is open for the
    ambulance.
    • Escambia County EMS will call Baptist Life Flight Communications Center (850-434-4586) and notify them of the dive accident.
    • The injured diver will be transported to the chamber by the most expeditious method – typically Baptist Life Flight - with Escambia County EMS ground ambulance as the backup.
    • Backup telephone numbers for Coast Guard:
    Coast Guard Station Emergency Search and Rescue Line
    850-453-8178
    Coast Guard Station Main Number
    850-453-8282
    • If no communications can be established with Coast Guard Station Pensacola, call Escambia County (FL) 911 on cell phone when feasible, tell them that you have a diving accident, and ask for them to relay your call to the Coast Guard. Request that 911 record your vessel name, location, cell phone number, and the nature of the emergency to provide to the Coast Guard when transferring the call.


    Dive Boat Captain Passes the Following Information to the Coast Guard
    • First Transmission
    1. Name and location of vessel
    2. Nature of distress – scuba diving accident
    3. Name, age and sex of casualty
    4. Dive profile
    Depth/time
    Gas mix used on dive
    Time of surfacing
    Omitted decompression?
    Emergency ascent made by diver?
    5. Presenting signs and symptoms
    6. Current status
    Conscious Yes/No
    Breathing difficulty Yes/No
    Pain Yes/No Where?
    Weakness/Paralysis Yes/No Where?
    Sensory loss Yes/No Where?
    • Second Transmission
    Provide Coast Guard requested information outlined in Appendix A


    Which Chamber Should the Injured Diver Be Evacuated To?
    • Baptist Hospital (Pensacola, FL) is PRIMARY
    Two monoplace chambers
    24-hour bends watch
    Can do two treatments simultaneously
    Can treat only one ventilated patient at a time
    Does not recompress unconscious or critical patients
    Staff trained in management of diving accidents
    Has emergency room capability
    • Springhill Medical Center (Mobile, AL) – Second Option
    Two-person chamber
    24-hour bends watch
    Staff trained in management of diving accidents
    Will recompress unconscious or critical patients
    60 miles from Pensacola
    • Capitol Regional Medical Center (Tallahassee, FL) – Third Option
    Multiplace chamber
    24-hour bends watch
    Staff trained in management of diving accidents
    Will recompress unconscious or critical patients
    180 miles from Pensacola

    * Note: Baptist Life Flight may or may not be able to reach Capitol Regional Medical Center without refueling - depends on flying conditions.


    Who Makes the Call on Where the Casualty Goes after the Injured Diver Is Transferred to EMS at the Coast Guard Station Pensacola Pier?
    • The Baptist Hospital Emergency Department physician
    - Has responsibility for supervising air/ground emergency transport.
    - This is not a Dive Boat Captain or Coast Guard call.
    __________________

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    Re: Oriskany Accident Managment Document

    Thank You Heather. Have some green.

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    Re: Oriskany Accident Managment Document

    Indeed, and thanks for posting it here.

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    Re: Oriskany Accident Managment Document

    Thanks for posting Heather... helpful to those of us organizing trips there... will not be borrowing doubles from you this year though! :)

    Take care

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    Re: Oriskany Accident Managment Document

    Thanks, we'll be around if you need anything, even if it's just pints ;).

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    Re: Oriskany Accident Managment Document

    All that thought, and no mention of cardiac defibrillation equipment or training?

    Short money for such an important piece of equipment... Peter

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    Re: Oriskany Accident Managment Document

    Quote Originally Posted by Peter Piemonte  View Original Post
    All that thought, and no mention of cardiac defibrillation equipment or training?

    Short money for such an important piece of equipment... Peter
    They were discussed. However, according to the medical folks and those who are familiar with them- the patient must be flat, which can be difficult on a dive boat deck (especially some of the smaller boats) AND (perhaps more importantly) the lack of a dry area for use was considered too big a hazard.

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    Re: Oriskany Accident Managment Document

    Quote Originally Posted by hchoat  View Original Post
    They were discussed. However, according to the medical folks and those who are familiar with them- the patient must be flat, which can be difficult on a dive boat deck (especially some of the smaller boats) AND (perhaps more importantly) the lack of a dry area for use was considered too big a hazard.
    I did a BSAC AED course just a couple of months ago, their reasoning for approving the training was almost the opposite to that- most boats have somewhere you can lay someone flat (if not its too small to be diving from!) and as long as the divers chest is dry thats all that matters.
    The risk of a shock to the rescuers is proportional to the distance you are from the casualty even if they are laying on a wet deck, 2-3ft away you are completely safe, even 6" away you are unlikely to recieve more than an almost undetectable belt (and chances are you'll be wearing rubber!)

    Secondly the proceedures and details listed are a great resource for diving the Oriskany and the team who compiled it should be praised but.... (no offence) shouldn't the vast majority of that data (with perhaps the exception of the specific addresses of the hospitals and coastguard proceedures) be knowledge that all divers have recieved during their training, particularly those trained sufficently to consider diving to those depths offshore?

    I don't know what the typical diver training in the US is like, or who certifys the majority of divers (PADI perhaps?) I only know what we do here (In England under BSAC regulations) but I would hope the majority of my club members know their BLS (Basic Life Support) training, Oxygen Administration, have a nominated Dive Marshall, confirm dive plans with the skipper, know how to summon the coastguard even without the skippers assistance etc.

    I know we have the advantage in the UK of almost total air support from the coastguard/navy/air force and in alot of cases can lifted straight off the boat within half an hour max but I would be very dissapointed if the divers and skipper didn't just swing into action without the need to refer to a checklist in the even of a DCI incident, its there job afterall!

    Its a great resource and I don't want to take anything away from that- I'm just thinking that it smacks of "nannying" and is abit presumptuous? I want to reiterate- I thinks its great but I think its stuff that shouldn't need saying?

    Just my very humble oppinion,

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    Re: Oriskany Accident Managment Document

    Quote Originally Posted by hchoat  View Original Post
    They were discussed. However, according to the medical folks and those who are familiar with them- the patient must be flat, which can be difficult on a dive boat deck (especially some of the smaller boats) AND (perhaps more importantly) the lack of a dry area for use was considered too big a hazard.

    Heather: We train with these in aircraft all the time. There is a lot less room available to us in that application than on a typical cattle boat.

    As Ben pointed out, the other concerns were not factual.

    In my experience safety always takes a back seat to money. That I think is the real problem... Peter

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