student book / en · should the sa node fails to generate an impulse, another site in the network...

Student book / EN

DAN Automated External Defibrillation 1

Student Handbook

DAN Automated External Defibrillation

Co-Editors: Guy Thomas, Bill Clendenen.Authors: Eric Douglas DMT (principal author), Guy Thomas EMT.

Contributors: Mark Butler, Jim Caruso M.D., Frans Cronjé M.D., Joel Dovenbarger, Dave Lawler, John Lippman, Yoshiro Mano M.D., Alessandro Marroni M.D., Karen B. Van Hoesen, M.D., Kimberley Walker

Photos: Guy Thomas, Marjo Maebe (picture arrival EMS)

Medical Programme Coordinator: Prof. Alessandro Marroni

© 2011 Divers Alert Network

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or trans-mitted, in any form or by any means, electronic mechanical, photocopying or otherwise, without prior

written permission of Divers Alert Network, P.O. Box DAN, 64026 Roseto, Italy.

First English Edition published January 2002Second Edition published in September 2006

Third Edition published in May 2011

Divers Alert Network Contact Information

DAN Southern AfricaPrivate Bag X197, Halfway House, 1685

DAN Building, Rosen Office ParkCnr Invicta & Third RoadsHalway Gardens, Midrand

Tel: +27 11 266 4900Fax: +27 11 312 0054

Website: www.dansa.orgEmail: [email protected]

DAN Automated External Defibrillation2

Table of Contents

DAN Training would like to thank those individuals who, through their tireless efforts and dedication, have made the development of the DAN training programmes a reality. Their actions make a difference in dive safety.

Automated External Defibrillation - Sudden Cardiac Arrest 3

Course Overview 3Knowledge Development 3Skills Development 3Assessment and Certification 3Prerequisites 3Learning Objectives 4Refresher training 4

Section 1. Automated External Defibrillation - Sudden Cardiac Arrest 5

Sudden Cardiac Arrest - Is This Serious? 5How Does This Apply to Diving? 5What Happens During Sudden Cardiac Arrest? 6Defibrillation — The Treatment for Ventricular Fibrillation (VF) 8Who Can Provide Defibrillation? 10What About CPR? 11You should continue to provide CPR 12Providing Emergency Care 12REVIEW QUESTIONS 13

Section 2. Automated External Defibrillation Skills Development 15

Skills Overview: 15Scene Safety Assessment 16Initial Assessment with Basic Life Support 17Basic Life Support with Supplemental Oxygen (optional) 21Providing Care with an AED 22AED Equipment Maintenance 25Emergency Assistance Plan 26AED Treatment 27Turn over to EMS 28Safety considerations 29Other Considerations 30AED Maintenance 33REVIEW QUESTIONS 34

Regulatory Issues 36

Section 3. Cardiovascular Disease and Diving 37

Why Divers Should Stay Physically Fit 37

Review Questions 45

Automated External Defibrillation Course Evaluation 46



Course OverviewThis course is designed to train and ed-ucate the general diving (and qualified non-diving) public in the techniques of using an Automated External Defibrilla-tor (AED) for victims of a cardiac arrest. In addition, this course also reviews first aid procedures using Basic Life Support techniques.

This programme also provides an excellent opportunity for experienced divers and instructors to continue their education.

Knowledge DevelopmentThe Knowledge Development portion of this course is designed to provide in-formation that will allow you to:

1. Recognise the signs of sudden cardiac arrest

2. Provide Basic Life Support while setting up the AED

3. Provide Basic Life Support with an AED

4. Care for and maintain an AED.

You will have to attend a lecture provided by your DAN AED Instructor. The hand-book supplies information in a simple, easy-to-understand manner. At the end of each section, review questions are pro-vided to help you assess your comprehen-sion of the material previously covered.

Skills DevelopmentThe skills development portion of the course will give you an opportunity to use basic first aid skills, and, under the guidance of a DAN Instructor, to assist an injured person with a simulated car-diac arrest. This hands-on part of the course is de-signed to have you apply what you have learned in the knowledge development part of this course and any previously learned CPR/BLS skills.

Assessment and CertificationUpon completion of the DAN Automat-ed External Defibrillator course, you will receive a DAN AED Provider Card indicat-ing that you have been trained to pro-vide first aid with an AED to a victim of a cardiac arrest. As you progress through the course, you will demonstrate mastery of the knowledge and skills necessary to correctly provide first aid.

PrerequisitesThe key to successfully beginning the chain of survival is Basic Life Support or Cardiopulmonary Resuscitation (CPR). This course relies heavily on this knowl-edge base as a prerequisite to providing care with an AED. You will need to show proof of having completed CPR training from a recognised training association.

Automated External Defibrillation -

Sudden Cardiac Arrest


Learning ObjectivesAt the end of this programme you will be able to:

1. Recognise the warning signs of sudden cardiac arrest.2. Provide Basic Life Support while setting up the automated external

defibrillator.3. Provide Basic Life Support with an AED.4. Providing care with an AED.5. Care for and maintain an AED.

The nature and scope of this course is limited to training divers and interested non-divers such as boat captains, water enthusiasts and non-diving family members to provide emergency cardiac care with an Automated External Defibrillator. This course does not provide training for cardiopulmonary resuscitation (CPR) or scuba diving rescue. The training exercises of this course presuppose that the ill or injured diver has already been brought to shore or is aboard the boat.

Refresher trainingThe DAN AED Provider license is valid for 2 years. Refresher training should be car-ried out every 2 years. However, more often is recommended for this kind of train-ing programme.



Section 1 | Automated External Defibrillation Sudden Cardiac Arrest

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Automated External Defibrillation -

Sudden Cardiac ArrestSudden Cardiac Arrest - Is This Serious?Sudden Cardiac Arrest (SCA) kills. In Europe more than 700.000 people die each year from SCA, making it a leading cause of death and the leading cause of death for people over 35.The causes of sudden cardiac arrest in-clude: • Heart Disease• Electric Shock

SCA doesn't necessarily happen in a physically stressful environment. It happens while diving, in airports, shop-ping malls, on the beach, or on a boat - even at home. It can also happen with little or no warning. However, there are several warning signs you should learn to recognise.

Warning Signs of Sudden Cardiac Arrest• Heavy pressure or squeezing pain or

discomfort in the centre of the chest behind the breastbone.

• Shoulder, arm, neck or jaw pain and discomfort

• Shortness of breath• Sweating• Nausea and vomiting• Denial

The term “massive heart attack” is often used to describe a sudden cardiac arrest.

“Heart attack” refers to heart muscle death caused by loss of blood supply — not necessarily resulting in death. All types of heart disease can lead to sudden cardiac arrest, and half of all deaths from heart disease are sudden and unexpected.

How Does This Apply to Diving?Many divers are getting older, and older people are getting involved in diving. Each year, the average age of DAN Mem-bers increases slightly.

The mean age of divers who die each year in dive fatalities tracked by DAN is gradually increasing. It is now approxi-mately 42 years of age.

Of the 78 dive fatalities in the DAN 2001 Report on Decompression Illness, Diving

Fig. 1: Pain in the centre ofthe chest is a commonsymptom of aheart attack

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Fatalities and Project Dive Exploration, based on 1999 fatalities, 7.7 percent of them were caused directly by heart dis-ease. At the same time, heart disease was the direct cause of death for 26 percent of the fatalities involving divers over the age of 35.

On top of that, 25 percent of divers in-volved in diving fatalities were also re-ported to be taking heart medications.

Heart disease is a common problem. When you consider that diving is often done from remote locations — on beaches or off dive boats — that are far removed from emergency medical help, it is important to prepare for every emergency.

What Happens During Sudden Cardiac Arrest?The HeartThe heart is a hollow muscular organ situated in the chest between the lungs in a space called the mediastinum. The heart, like the lungs, is surrounded by a thin connective tissue sac, the peri-cardium that allows the heart to beat independently without friction. The heart is situated obliquely, one-third to the right and two-thirds to the left of the sternum.

The heart is a strong muscular pump that, in the average adult, beats about 60-100 times per minute. Every minute, ap-proximately 6 litres of blood is pumped throughout the body. When exercising, this output doubles or triples depending upon the amount of exertion.

The heart consists of two separate pumps, one on the left side and one on the right side. Each pump has two chambers. The upper chamber, or atri-um, receives blood from the body or the lungs, and the lower chamber, the ventricle, is filled with blood from the atrium. The pumps work by muscular contractions squeezing the blood out of the chambers. The left ventricle pumps oxygenated blood throughout the body in what is known as the systemic circuit, and the right ventricle pumps deoxy-genated blood (blood returning to the heart) to the lungs in what is known as the pulmonary circuit.

The heart muscle is supplied with blood by a network of arteries, the “coronary arteries”. These branch of from the base of the main artery that leaves the heart (the aorta). They also direct deoxygen-ated blood back towards the right side of the heart.

The electrical system of the heartThe heart has a channel of specialised tissue called conductive fibers that dis-tribute electricity throughout the heart. This is known as the “electrical” system of the heart.

This network delivers electrical impuls-es directly to the cardiac muscle tissue, which is stimulated to contract and pump blood. The pumping of the heart is the “mechanical” activity which results in a pulse. Without an electrical signal the heart will not pump.

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Pacemakers

The conductive fibers have the unique ability to generate their own electrical impulses. The heart’s primary impulse generator is the sinoatrial (SA) node lo-cated in the right atrium. It is called the primary pacemaker because it is the site that normally generates impulses.

The conductive fiber network carries an impulse generated in the SA node through the cardiac muscle tissues of the atria. This causes the atria to con-tract. Next, the impulse travels through the network to the ventricles into the connecting blood vessels.

Should the SA node fails to generate an impulse, another site in the network will usually take over and generate impuls-es. The atrioventricular (AV) node is an example of one site along the network that can also be used as a pacemaker.

DysrhytmiasThe ECG of a healthy heart shows an un-organised, uniform rhythm called Nor-mal Sinus Rhythm (NSR). The persons with NSR will have a pulse. This pulse is produced by the heart’s pumping.

Dysrhytmias are abnormal heart rhythms that can prevent the heart from pump-ing properly. There are numerous causes of dysrhythmias including:

• Narrowing an hardening of the arteries of the heart (coronary heart disease)

• Chemical imbalances• Trauma to the heart muscle• Low Blood oxygen levels

(drowning, suffocation)• Central Nervous System damage• Drugs and Medications• Electrocutions• Hypothermia (low body

temperature)

Coronary heart disease is a major cause of cardiac arrest. A heart attack is caused by heart disease too. However, when someone has a heart attack, the heart does not usually stop beating.

Fig. 2: The sinoatrial node is the impulse-generating (pacemaker) tissue located in the right atrium of the heart

Sinus Node

AV Node

ConductionPathways

2

Fig. 3: ECG of a healthy heart - NSR

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1.4A heart attack occurs when a blood clot suddenly blocks a coronary artery and the heart is deprived of oxygen.

The outcome depends on the extend to which the heart muscle is affected. Many heart attack victims recover com-pletely. In a number of victims however, the normal electrical signal will be dis-turbed and turned into a chaotic rhythm called “ventricular fibrillation”. The heart will contract in a completely disorgan-ised way. The result is cardiac arrest.

Ventricular FibrillationSudden Cardiac Arrest (SCA) means that the heart has stopped beating unex-pectedly. The most common dysrhyth-mia associated with SCA is ventricular Fibrillation (VF). VF is an unorganised rhythm in which many sites in the heart attempt to function as the pacemaker. The chaotic electrical activity results in uncoordinated and ineffective cardiac muscle contractions which prevent the circulation of blood. There is no pulse or blood pressure. A heart in VF looks like a quivering bowl of jelly.

Defibrillation — The Treatment for Ventricular Fibrillation (VF)Regardless of the cause, when the heart stops beating, if you can't reset the heart's rhythm, the person will die. The only way to reset a heart in ventricular fibrillation (VF) is with defibrillation.

The goal of defibrillation is to reorganise the chaotic electrical activity of VF and return the heart to a normal rhythm. After a shock the SA node or another area of the heart can regain control as the primary pacemaker.

For years, you've learned about cardi-opulmonary resuscitation (CPR). While CPR delays the inevitable by helping to oxygenate blood and circulate it throughout the body, CPR cannot reset the heart rhythm and make it begin beating again.

Only defibrillation can do that.

While few good statistics for out of hos-

Fig. 4: ECG of a heart in VF

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Fig. 5: Defibrillation: from VF to NSR

Shock

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pital CPR exist, the American Heart As-sociation and the International Liaison Committee on Resuscitation (ILCOR) maintains that the early use of CPR and rapid defibrillation, combined with early advanced care, can result in long-term survival rates for witnessed ventricular fibrillation as high as 40 percent.

Defibrillation sends an electric shock through the heart, via the disposable elec-trodes or pads and essentially hits a “reset” button. The electrodes are positioned so that the charge will pass through the heart. The electrical shock doesn't tell the heart how to beat or contract. What it does is scramble all of the misfiring signals and stop all of the electrical activity. The heart stops for a moment, and the body's natural pacemaker begins firing again, re-storing a normal rhythm.

When defibrillation is provided within the first few minutes after VF begins, the person has a very high survival rate. Every minute defibrillation is delayed, the chance of survival drops by 7 to 10 percent.

While this course is dive-oriented, AEDs are effective for treating SCA in any en-vironment. The skills you learn in this course are transferable to any situation.

Other DysrhythmiasIf you arrive early on the scene of a car-diac arrest you will be more likely to find VF or pulseless ventricular tachycardia (VT). Pulseless VT is a rhythm that often precedes VF. It occurs when a site in the ventricular muscle fires rapidly and takes over as the dominant pacemaker. As the heart rate increases, there is less time for the ventricles to fill with blood.

This reduces the amount the heart can pump and blood pressure falls. If the blood pressure drops severely, con-sciousness and pulse will be lost. Both VF and VT are treated with electrical shocks.

There are some dysrhythmias of cardiac arrest which are not treated with electri-cal shocks. Asystole (also known as “flat line” or no electrical activity in the heart) and pulseless electrical activity (“PEA” - electrical activity but no pumping of the heart) are examples of dysrhythmias that do not respond to external shocks.

Fig. 6: View of defibrillator electrode position and placement

High energyshock

Low energyshock

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ElectrocardiogramsThe electrocardiogram (ECG) is a meas-urement of the electrical activity in the heart. The impulses from the heart pass through body tissues and reach the skin. The electrical energy can be de-tected by disposable electrodes placed on the skin.

The heart’s electrical signals detected on the skin are a very low voltage so they must be amplified by the AED.

Artefacts may be induced by: victim movement, muscle tremors, use of dried out or poor quality electrodes, loose electrodes and interference from electronic devices and lightning.

Who Can Provide Defibrillation?Until recently, it required a tremendous amount of training to operate a defibril-lator. You had to understand the heart rhythms (ECG interpretation) on the monitor before you could administer a shock. If the person wasn't already in ven-tricular fibrillation when you applied the shock, you could put him there. The nec-essary training required made defibrilla-

tors the domain of medical profession-als. Doctors and nurses could use them in the hospital, or paramedics could use them at the scene of an emergency. Unfortunately, survival rates drop by about 7 to 10 percent every minute a person is in ventricular fibrillation. Long response times from emergency medi-cal services professionals decrease the effectiveness of defibrillators in the field.

Defibrillation technology has evolved to give us Automated External Defibrilla-tors (AEDs) which simplify defibrillation operation and greatly reduce the train-ing needs to use a defibrillator.ECG interpretation (analysing of the heart) is done by software internal to the defibrillator that has been tested in thousands of simulated cases in the laboratory and clinically field tested.

Remark: AEDs also amplify any other electrical sig-nals (called artefact) detected by the dispos-able electrodes. It is important to minimise all movement and extraneous sources of electri-cal signals because they could be confused with or mask the heart’s electrical activity

Fig. 7: Defibrillation is a common treatment for life-threatening ventricular fibrillation

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1.6

AEDs are designed to advise the operator if a “shockable” rhythm is detected VF or Pulseless VT). If a non-shockable rhythm is detected it is designed to give the op-erator a “ no shock advised” message.

You don't need a lot of special training to operate an AED. They are simple to operate and, on some occasions, peo-ple have saved the lives of friends, co-workers and complete strangers using AEDs they'd never used before, strictly by listening to the unit and following its directions. However, training is obliga-tory and often required to purchase the device.

To be comfortable using a piece of equipment, and to purchase an AED, most people need training. Training allows you to be faster and more con-fident about your actions. If, by taking this course, you can increase your re-sponse time to using an AED by a few minutes, you may improve someone's chance of survival by as much as 30 or 40 percent.

What About CPR? As you read earlier, CPR is still impor-tant in rescue. CPR and AEDs are part of the same chain of survival that you provide in any accident. They rely on each other; neither one is as successful without the other.

There are four links in the Chain of Sur-vival. All four of them have to be present to provide the best chance of survival. They are:

Early Access to the EMS SystemThe first link is still important. Even if you have an AED and can administer it immediately, a person whose heart has stopped is still going to need profes-sional medical care quickly. That's why Early Access to EMS is so critical.

Early CPRThe second link, Early CPR, keeps oxy-genated blood flowing to the body until a defibrillator is available. This keeps the body tissues from dying. Tissues like those in the brain and nervous system begin dying after four or five minutes without oxygen.

Early DefibrillationThe third link, Early Defibrillation, resets the heart and allows it to begin beating normally.

In most cases of cardiac arrest the heart muscle quivers due to “ventricular fibril-lation”. VF usually only lasts for few min-utes before the electrical activity stops (a systole). Therefore the sooner we can provide defibrillation, the higher the chance for survival.

Early Advanced Life Support The fourth link, Early Advanced Life Sup-port, brings medications and advanced procedures to the person who has suf-fered a sudden cardiac arrest improving the odds of survival that much more.

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1.8

1.7 You should continue to provide CPR:• Until AED arrives.• Until AED is attached and ready

to use (if there is more than one rescuer).

• After 1 shock with no response (*).• After a no-shock advisory, when

victim is not breathing normally (*).• If device is unavailable.

(*) Provide CPR for two minutes, then AED will analyse again.

Providing Emergency CareAdding a defibrillator to basic life support procedures really doesn't alter your emergency response greatly. You will still follow the ABCs and simply add a “D” for defibrillation.

Note:Teaching Basic Life Support techniques are not part of the AED programme, but may be taught as an additional module with this course. They are included here as a refresher only. Taking a BLS course prior to this course will make you more familiar with the steps necessary to assist someone in an emer-gency.

Fig. 9: AED is designed to be simple to use for the layman

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Fig. 8: After the shock the AED will prompt you to start CPR. Do not wait—start CPR immediately and alternate 30 chest compressions with 2 rescue breaths

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Review answers are on page 45

Section 1REVIEW QUESTIONSWrite your answer in the space provided.

1. Sudden cardiac arrest include __________ and __________.

2. Warning signs include: (Check all that apply)❍❍ Heavy pressure in the center of the chest behind the breastbone❍❍ Sholder, arm, nek or jaw pain and discomfort❍❍ Shortness of breath❍❍ Sweating❍❍ Nausea and vomiting ❍❍ Denial❍

3. When defibrillation is provided within the first minutes after VF begins, the person has a very high ____________ rate.

4. There are 4 links in the chain of survival: __________, __________, __________ and __________.

5. You should continue to provide CPR: (Check all that apply)a. Until AED arrives, set up and ready to useb. After 2 consecutive shoks with no responsec. After 1 shock with no responsed. After no shock advisory, when victim is not breathing normally

Section 1 | Review Questions

Wherever you are DAN is therewww.dansa.org

Wherever you are DAN is therewww.dansa.org


Section 2 | Automated External Defibrillation Skills Development

Automated External Defibrillation Skills Development

Skills Overview:1. Scene Safety Assessment

2. Initial Assessment with Basic Life Support

3. Basic Life Support with Supplemental Oxygen

4. Providing care with an AED

5. AED Equipment maintenance

6. Emergency Assistance Plan



Scene Safety Assessment

REMEMBER S-A-F-E

1. S – Stop• Stop.• Think.• Act.

2. A - Assess Scene• Is the scene safe?• Is it safe to approach the injured diver?• Is the ventilation adequate for oxygen?• Do other divers need to be recalled?• Any other hazards present?

3. F - Find and locate first Aid kit, Oxygen unit and AED • First Aid Kits contain critical supplies such as barriers.

4. E - Exposure Protection: - Body Substance Isolation• Use barriers such as gloves and mouth-to-mask barrier devices (Fig. 10 - 11 - 12).

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Initial Assessment with Basic Life Support

1. Make sure you, the injured person and any bystanders are safe

2. Check the injured person for a response • State your name, training and desire to help.• Ask permission to help.• Gently shake the injured person’s shoulders and ask loudly: “are you all

right?” (Fig. 13)

3a. If he responds:• Leave him in the position in which you find him provided there is no

further danger.• Try to find out what is wrong with him and get help if needed.• Reassess him regularly.

3b. If he does not respond:• Shout for help.• Turn the injured person on his back and then open the airway using head

tilt and chin lift:• Place your hand on his forehead and gently tilt his head back (Fig. 14). • With your fingertips under the point of the injured person’s chin, lift the

chin to open the airway (Fig. 15).

4. Keeping the airway open, look, listen and feel for breathing• Look for the chest movement.• Listen at the injured person’s mouth for breath sounds.• Feel for air on your cheek.• Decide if breathing is normal, not normal or absent.

In the first minutes after cardiac arrest, an injured person may be barely breathing, or taking infrequent, noisy gasps. Do not confuse this with normal breathing. Look, listen and feel for no more than 10 seconds to determine whether the injured person is breathing normally (Fig. 16). If you have any doubt whether breathing is normal, act as if not normal.

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5a. If he is breathing normally:• Turn him into the recovery position.• Send or go for help / call an ambulance (Fig. 17).• Continue to assess that breathing remains

normal.5b. If the breathing is not normal or absent:

• Send someone for help and to find and bring an AED if available; or, if you are on your own, use your mobile phone to alert the ambulance service - leave the injured person when there is no other option;

• start chest compressions as follows:• Kneel by the side of the injured person;• Place one heel of one hand in the centre of the

chest (which is the lower half of the injured person’s breastbone (sternum));

• Place the heel of your other hand on top of the first hand:

• Interlock the fingers of your hands and ensure that pressure is not applied over the injured person’s ribs. Keep your arms straight, do not apply pressure over the upper abdomen or the bottom end of the sternum (Fig. 18);

• Position yourself vertically above the chest and press down on the sternum at least 5cm (but not exceeding 6cm) (Fig. 19);

• After each compression, release all the pressure on the chest without loosing contact between your hands and the sternum; repeat a rate of at least 100/minute (but not exceeding 120/minute);

• Compression and release should take equal amounts of time.

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6a. Combine chest compressions with rescue breaths.• After 30 compressions open the airway again using the head tilt and

chin lift.• Use an oronasal resuscitation mask or pinch the soft part of the nose closed,

using the index finger and thumb of your hand of the forehead (Fig. 20).• Allow the mouth to open, but maintain chin lift.• Take a normal breath and place your lips on the inlet of the oronasal

resuscitation mask, or around his mouth, making sure that you have a good seal (Fig. 21).

• Blow steadily in to the mask / mouth while watching the chest to rise, taking about 1 second as in normal breathing; this is an effective rescue breath.

• Maintaining head tilt and chin lift, take your mouth away from the injured person and watch for the chest to fall as air comes out.

• Take another normal breath and blow into the person’s mouth (or in the mask), to achieve a total of 2 effective rescue breaths. The two breaths should not take more than 5 seconds in all. Then return your hands without delay to the correct position on the sternum and give another 30 compressions (Fig. 22).

• Continue CPR in a ratio of 30:2.• Stop to recheck the injured person only if he starts to wake up: to move,

open eyes and to breath normally. Otherwise do not interrupt resuscitation.

• If your initial rescue breath do not make the chest rise as in normal breathing, then before your next attempt:• Check the injured person’s mouth and remove any obstruction.• Recheck that there is adequate head tilt and chin lift.• Do not attempt more than 2 breaths each time before returning to

chest compressions.

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• If there is more than one rescuer present, another rescuer should take over delivering CPR every 2 minutes to prevent fatigue. Ensure that interruption of chest compressions is minimal during the changeover of rescuers.

6b. Chest-compression-only CPR may be used as follows:• If you are not trained, or are unwilling to give rescue breaths, give chest

compressions only.• If chest compressions are given, these should be continuous, at a rate of at

least 100/minute (but not exceeding 120/minute).

7. Do not interrupt resuscitation until:• Professional help arrives and takes over; or• The injured person start to wake up: to move, opens eyes and to breathe

normally; or• You become exhausted.

Note:For victims of drowning: Give 5 initial rescue breaths before starting chest compressions and perform 1 minute of CPR before getting help.



Basic Life Support with Supplemental Oxygen (optional)

Follow the Adult BLS sequence as described before.

The Use of supplemental Oxygen Oxygen first aid should be provided as soon as equipment becomes available.

• If diver is breathing, provide oxygen using:

• Demand inhalator valve with oronasal mask (Fig. 23); or• Non-rebreather mask with a minimum 15 lpm of oxygen flow

• If diver is not breathing, set up oxygen unit, attach oxygen tubing to oronasal resuscitation mask (Fig. 24) and set flow rate to 15 lpm. Continue rescue breathing.

REMEMBER• Maintain an open airway.

• If vomit or other fluids are visible in the airway, turn the diver on the side and clear the airway.

AVOID• Contact with blood or

other body fluids.

• Delay in providing rescue breaths to set up oxygen equipment.

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Providing Care with an AED

Make sure you, the victim and any bystanders are safe

Follow the Adult BLS sequence

• Unresponsive and not breathing normally: Send someone for help and to find an bring an AED if available

• If you are on your own, use your mobile phone to alert EMS – leave the victim only when there is no other option

Start CPR according to the Adult BLS sequence. If you are on your own and the AED is in your imme-diate vicinity, start with applying the AED (Fig. 25)

As soon as AED arrives:

• Switch on the AED and attach the electrode pads on the victim’s bare chest – It may be necessary to cut away clothing or wetsuits – Chest must be dry ,wipe it off if necessary (Fig. 26 - 27)

• If more than one rescuer is present, CPR should be continued while electrodes are being attached to the chest.

• follow spoken / visual directions

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• Remove the pads from the bag (Fig. 28).• Place the defibrillator pads on the person (Fig. 29).• Apply the pads firmly to the chest. Right and left refer to the patient's right

and left (Fig. 30-31). • Place the right pad on the upper right chest, just below the collarbone and

to the right of the breastbone (Fig. 32). • Place the left pad on lower left ribs just below the breast.

Note: Pad position does not have to be exact.

• Follow the verbal and text prompts the AED unit provides.• Make sure the electrodes are plugged into the AED (Fig. 33).• AED will analyse the rhythm as soon electrodes are attached to AED/chest.

– In some older AED models an analyse button needs to be pushed

• Ensure that nobody is touching the victim while the AED is analysing (Fig. 34).

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Notes:• The training materials that accompany this course focus on one model of AED. How-

ever, this isn't the only AED available. While most of the features on this AED apply to all AEDs, there may be specific operations that vary by brand and model. Operators should be familiar with the AED they will use.

• During the skill session of this course, you will perform different AED scenarios.

If shock is indicated:• Look to see that no one is touching the person (Fig. 35) by scanning the

person head to toe and state: “I'm clear, you're clear, all clear” or simply “clear.” • Deliver the shock, by pressing the shock button (Fig. 36), if indicated and safe.

– Full automatic AED’s will automatically deliver the shock

• Immediately restart CPR 30:2 (Fig. 37 - 38).• Continue as directed by the voice / visual prompts.

If no shock is indicated:• Immediately resume CPR, using a ratio of 30 compressions to 2 rescue breaths• Continue as directed by the voice / visual prompts

Continue to follow AED prompts until:

• Qualified helps takes over• The victim starts to wake up: moves, open eyes and breathes normally• You become exhausted

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AED Equipment Maintenance

Follow the manufacturer’s recommendations for a periodic equipment check.

Check Battery

• Must have enough power for one complete rescue

• Run Self test• Check expiration date on supplies: If

expired, replace it (Fig. 39).

Stock up after use

• Defibrillator Pads.• First Aid supplies including gloves.• Towel or cloth to dry the chest

Clean Oronasal Resuscitation Mask

Reassemble unit and store ready for use

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Diver Information: Name: ______________________________________ Age: ____________________ Address: ______________________________________________________________Emergency Contact Phone: _______________________________________________Current Complaint: _________________________________________________________________________________________________________________________________________________________________________________________________

Significant Past Medical History (medications, allergies, previous injuries, etc.):____________________________________________________________________________________________________________________________________________

Dive Profile (Including S.S/Deco) Depth Time Surface Interval Dive # 1 Dive # 2 Dive # 3 Dive # 4 Dive # 5

Exit Water Time: _________ AM/PMBreathing Gas: Air / Nitrox / Mix_________ %

Emergency Assistance Plan

Initial contact information: _______________________________________________Emergency Medical Assistance: ___________________________________________Nearest Medical Facility Directions: ______________________________________________________________________________________________________________Phone: _______________________________________________________________Diving Medical consultation Information: ___________________________________Divers Alert Network (DAN) Hotline: ________________________________________Other important information: _________________________________________________________________________________________________________________________________________________________________________________________Phone: _______________________________________________________________

Emergency Assistance PlanThe following information is critical in managing scuba diving injuries and illnesses.

2.6



AED Treatment

The AED unit will analyse the heart's rhythm and decide if the person’s heart needs an electric shock.

• Immediately after giving a single shock, and without reassessing the rhythm or breathing, resume CPR (30 compressions: 2 ventilations) for 2 minutes before delivering another shock (analysing)

• If a rhythm has been restored, giving chest compressions does not increase the chance of VF recurring

• After 2 minutes, the AED will reanalyse the heart’s rhythm• Ensure nobody is touching the victim.

• Continue as directed by the voice / visual prompts.

When the victim starts breathing normally, place the person in the recovery posi-tion and leave the AED attached.

Continue to check breathing and listen for any further prompts by the AED.

If the AED unit decides no shock is required, the rescuer should:

• Immediately resume CPR 30:2 for 2 minutes (Fig. 40 - 41).• Continue as directed by the voice / visual prompts• Continue until:

• Qualified help arrives and takes over• The person starts to wake up: moves, open eyes and breathes normally• You become exhausted

40 41

2.7



Turn over to EMS

While you are waiting for emergency medical personnel to arrive, the rescuer should:

• Continue to monitor the ABCs.• Leave AED in place.

When EMS personnel arrive (Fig. 42):

• They may ask you to continue to provide care while they set up.

• They may use your AED pads or remove them and use their own.

Provide a brief report so they can treat the person accordingly, indicating:

• Nature of the dive accident or incident• Initial condition• Care delivered• Current condition• Estimated time diver was not breathing and without circulation

2.8

42



Safety considerations

• Attach the AED unit only to victims in sudden cardiac arrest (Fig. 43).

• Do not touch the patient during analysis or shock delivery.

• Verbally and visually clear the patient. State “I’m clear. You’re clear. All clear.”

• Wet surfaces can create an arc between the pads or to the rescuers. Remove patient from standing water and dry chest (also see “other considerations”).

• Place patient on a back board if possible. AEDs may be used on metal surfaces.

• Do not place pads over medication patches. Remove patch and wipe chest before applying pads. These patches could cause sparking or burns during defibrillation.

• Remove any other plasters or other material attached to he victim’s chest to ensure good electrode contact.

• When delivering high concentrations of oxygen, sparking from poorly applied electrodes can cause a fire or significant burns. The risk of fire or burns during defibrillation can be minimised by removing the oxygen mask from the victim’s face and placing it at least 1 meter away from his chest.

• Victims with a hairy chest may have air trapping beneath the electrode and poor electrode-to-skin electrical contact. This can have sparks from electrode to skin and electrode to electrode as a result and is more likely to cause burns to the victim’s chest. Rapid shaving on the area where he electrodes will be applied may be necessary, but do not delay defibrillation if a shaver is not immediately available. It is recommended to keep a shaver with the AED.

43

2.9



Other Considerations

Wet environments• Wet chest: Some victims may have a wet chest (sweating, after a dive or after

rescue from water). You should dry the chest before attaching the electrodes to the chest. A small towel or a piece of cloth can be used and it is recommended to keep it with the AED when operating in wet environments (like during diving).

• Wet surfaces: A rescuer or bystander would not be exposed to any hazardous voltages if a patient was defibrillated on a wet surface as long as the appropriate safety precautions are taken. Specifically, no one touches the patient during the energy discharge when the shock button is pressed. As an extra safety precaution the attached AED cable should be extended away from the patient as far as possible before the defibrillation button on the AED is pressed.

Pacemakers • Do not place pads over pacemakers.• See manufacturer recommendations for use with pacemaker.• Place them at least one inch (two centimetres) away.

Internal Automated Cardiac Defibrillators (IACDs)• If an implanted device is delivering shocks - watch for signs of chest muscles

quivering — allow 30 to 60 seconds for implant to complete treatment cycle.• Do not place pads over IACD.• Place pads at least one inch (two centimetres) away.

Hypothermic PatientsWhen a patient is hypothermic with a core body temperature below 30°C, limit defi-brillation to a total of 3 attempts, until the core body temperature rises above 30°C.

If ventricular fibrillation persists:

• Continue Basic Life Support.• Continue attempting to passively rewarm the patient until transfer to EMS.

2.10



AEDs and childrenStandard AED’s are suitable for use in children older than 8 years. For children be-tween 1 and 8 years use paediatric pads or a paediatric mode if available; if these are not available, use the AED as it is.

• Don’t use AED for children less than 1 year.

AEDs in Transport• You can leave the AED in place while transporting the patient.• Avoid pushing the "analyse" button during transport.• The movement of the boat / ambulance can simulate a shockable rhythm and

cause the device to call for a shock (Fig. 44). • If shock is called for during transport or if the AED prompts the rescuer to check

the patient or recommends a shock, stop the vehicle, then reanalyse.• See manufacturer recommendations for other considerations.

44



Troubleshooting• Most AEDs will prompt the user as to the

nature of the problem and provide directions to fix it (Fig. 45).

• Stay calm and listen to the voice prompts.• Pad-related problems are the most common.

• Be sure to press firmly.• Lose pads may spark.• Check for obvious signs of damage.• Make sure cord is fully inserted.• Poor contact due to hair.

• Shave chest area where pad is placed.• Wet skin

• Dry chest with a towel or cloth.• Electrode pad adhesive dried out.

• Use a new set of pads.• Analysis interrupted.

• Stop all movement.• Don’t touch the patient.

• Radio Interference from radios and cell phone.• Keep them at least 1,8 meter / six feet away from the AED

45



AED Maintenance

• AEDs are designed to require minimal maintenance. Follow the manufacturer’s recommendations.

• Regularly check the batteries to make sure they are working.• Examine the pads and other components to make sure they have not exceeded

their expiration dates.• If they have, replace them

AED Flow Chart

Automated External Defibrillation Flow Chart

www.dansa.org

Unresponsive!

Open Airway: If not breathing normally

CPR 30:2 Until AED is attached:

Remember: Dry Chest

AED Analyses Rhythm

Shock Advised

Deliver Shock

Immediately resume CPR 30:2

for 2 minutes

No Shock Advised

Immediately resume CPR 30:2

for 2 minutes

Shout for help

Send or go for AED Call EMS

Continue until the victim start sto wake up: to move,

open eyes and to breathe normally

EN/11

2.11

Source: AED Algorithm, ERC guidelines 2010


?

Review answers are on page 45

Section 2REVIEW QUESTIONSWrite your answer in the space provided.

1. The first step to take in order to provide first aid with an AED is the __________ __________ assessment.

2. While you are waiting on another rescuer to set up the AED, what is the ratio of compressions to breaths for the one rescuer CPR?a. 5:1b. 15:1c. 30:2d. 5:2

3. To attach the defibrillator pads to the person in cardiac arrest, you have to bear the chest and make sure the chest is_________.

4. One pad goes on the upper chest, just below the collarbone and to the right of the breastbone. The other pad goes on the lower __________ , just below the __________.

5. True or False: To ensure good contact with the pads, you should hold them down to the patient’s chest during the shock.

6. True or False: After the AED delivered a shock, you have to reinitiate CPR?

7. Most of the problems experienced with the AED are with the pads, some of the more common problems to be aware include: (Check all that apply)a. Obvious signs of damage b. Poor contact due to hairc. Radio interference from radio’s and cell phonesd. Chest to dry.

8. AED ‘s are designed to require minimal maintenance. You should regularly check: (Check all that apply)a. The batteries to make sure the unit is ready to useb. The expiration date on the pads to make sure they are readyc. The additional components of the kit so everything is there when

you need it.

Section 2 | Review Questions


Regulatory Issues

It is not possible to offer a generic classification for AEDs as medical devices. Be-cause of this, you will need to seek local clarification in your country as to whether or not physician authorization is needed to both purchase and provide care with an AED.

Regulations and administrative codes vary widely, so you should always check with your Regional Office for more specific information for your area on obtaining an AED unit and any restrictions on its use.

However, there are no cases where lay rescuers have been successfully sued for providing care with an AED. Many countries have a Good Samaritan Law designed to protect rescuers who:

• Voluntarily provide assistance and are not legally obligated to do so.• Expect nothing in return.• Are not grossly negligent.

Overall, DAN believes AEDs are an important step in first aid for people who have SCA. They are already available in many resorts, cruise ships, airports, airplanes, ca-sinos and other places where people gather.


Section 3 | Cardiovascular Disease and Diving

3.1

Cardiovascular Disease and Diving

Why Divers Should Stay Physically FitBy James L. Caruso, M.D. - DAN On-Call Physician

Good cardiovascular health is one of the many pluses that can help you to keep diving actively for years to come.

A 52-year-old male diver loses conscious-ness while swimming along the bottom. Once the injured diver has been pulled out of the water, his dive buddy and other members of the dive group do their best to rescue him, including cardiopulmo-nary resuscitation (CPR) and calling for emergency medical services. The man, however, is pronounced dead at the local hospital.

The local medical examiner directs an au-topsy. The man was found to have an ab-normally enlarged heart and severe cor-onary artery disease. He was overweight and had smoked two packs of cigarettes a day and, aside from his occasional dive trips, had a sedentary lifestyle.

How might this tragic outcome have been prevented?DAN has published information on rec-reational scuba fatalities since 1989, two years after the first report on scuba inju-ries was published. It has been my hope

- and that of DAN collectively - that by analysing recreational scuba deaths, other scuba fatalities may be prevented. Each year I ask myself: Are we making some impact by publishing fatality sta-tistics? Are we preventing divers from making the same mistakes? It's a com-plex question.

There has been a decrease in recrea-tional diving fatalities over the last two years, and I hope this trend continues. We are currently at work on 83 fatalities for the 1999 report, based on 1997 sta-tistics.

There were 85 fatalities from recreation-al dives reported in 1996 - a significant decrease from the 104 deaths reported in 1995. This number is slightly lower than the average since 1980, which is 90 deaths per year.

But 83 deaths are still too many scuba fatalities. Halfway through 1998, DAN had already been notified of 32 recrea-tional diving deaths.

There is no way to tell if fatalities have decreased because of a greater educa-tional emphasis by DAN, training agen-cies and scuba instructors or because, as some popular dive areas have reported, there are fewer divers diving in the last three years. What we can say by review-ing scuba fatalities is this: We see many of the same causes and contributing factors each year.

3.1.1



The following article focuses on cardio-vascular disease. It can be both a cause of death while scuba diving and a con-tributing factor to drowning while div-ing. Could some of these fatalities have been prevented? Almost all scuba fatali-ties are preventable.

Ultimately, it is the individual divers who need to take health and fitness as seriously as they take diving. They need to regard their health maintenance, pro-moting fitness and avoiding illness - in the same way they maintain a properly functioning regulator and keep their tanks visually inspected. We will re-duce the number of recreational scuba deaths only if we all take them seriously.

Cardiovascular disease is the leading cause of death in the United States and other industrialised countries. But what is CV disease?

Cardiovascular disease is a broad cat-egory of health ailments that includes problems such as high blood pressure, coronary heart disease (coronary ar-teriosclerosis), stroke, rheumatic heart disease, and other less common dis-eases of the heart and blood vessels, such as congenital heart problems. In 1995, over 950.000 deaths in the United States were attributed to cardiovascular disease, representing 41.5 percent of all deaths that year (1).

It is estimated that 58 million Ameri-cans, or one in every five people, have one or more types of cardiovascular disease (2). Arteriosclerosis ("hardening," or occlusion by plaque) of the arteries of the heart accounts for a tremendous

number of hospital admissions, and millions of people take medication to prevent and treat the complications of coronary heart disease.

Scuba Divers and Cardiovascular Disease When it comes to heart disease, scuba divers are no different than the general population. Scuba diving fatalities due to the complications of cardiovascular disease are, unfortunately, all too com-mon. The problem may become even more significant as the number of older divers increases.

There is a significantly large number of older recreational divers who want to keep diving because this is an activity that they have enjoyed for years, per-haps even for decades. Additionally, an increased number of older individuals are participating in initial dive training courses. In many cases, these people may have reached a point in their lives when they finally have both the time and the financial means to engage in an activity that they have looked forward to enjoying for years.

At the 1997 annual scientific meeting of the Undersea and Hyperbaric Medical Society, Divers Alert Network reported on the number of recreational scuba diving fatalities in which cardiovascular disease was a factor. We looked through the DAN database for the years 1990-95 and found 66 fatalities (12 percent of the total number of deaths in 1990-95) in which cardiovascular disease was the

3.1.2



immediate cause of death or the lead-ing factor resulting in the death of a diver while participating in a recreation-al dive. When we looked at diving fatali-ties involving persons 35 years of age and older, the percentage of all fatalities that could be attributed to cardiovascu-lar disease increased to 26 percent (3).

Risk Factors The major risk factors for cardiovascular disease include cigarette smoking, high blood pressure, a diet high in cholester-ol and saturated fat, a family history of cardiovascular disease and a sedentary lifestyle.

Other facts of life include the following:

• Even with all other factors being equal, men have a higher risk of developing cardiovascular disease at a younger age than women;

• Cardiovascular disease increases in prevalence with increasing age; and

• You cannot alter risk factors for cardiovascular disease such as age, gender and family history.

Knowing these unalterable factors, your ideal goal should be to minimize what are known as the modifiable risk factors - smoking, diet and serum cholesterol level, blood pressure - and maximise your activity level.

Cigarette Smoking Arguably, cigarette smoking is the number-one preventable cause of pre-mature death and illness in our society. It has a negative effect on both cardiovas-cular fitness and pulmonary function.

Long-term cigarette use leads to emphy-sema, a condition in which the lung tis-sue loses its elasticity. This in turn makes oxygen exchange in the lungs much less efficient and can predispose a diver to pulmonary barotrauma and air embo-lism. Dive medicine specialists universal-ly consider emphysema a condition that is disqualifying for safe diving.

Nicotine also has a direct action on the blood vessels (including vasoconstric-tion), and chronic nicotine use may re-sult in hypertension, or persistent high blood pressure. The reality is that many divers smoke, but it certainly is in a diver's best interest to not use tobacco products of any kind.

HypertensionHypertension is a risk factor for both coronary artery disease and stroke. It contributes to the formation of athero-sclerotic plaques - irregularly shaped fat deposits, fibrous tissue and calcification in the arteries - and also results in an increase in the mass of the heart mus-cle itself. The complication here is that a larger heart requires more oxygen de-livery to the organ itself, but as the coro-nary arteries become occluded, they may deliver less oxygen to the heart.

3.1.3

3.1.4

3.1.5



Diet and regular exercise are the corner-stones of maintaining a desirable blood pressure. Often, however, medication is required to keep blood pressure within a satisfactory range. The risks associated with cardiovascular disease are depend-ent upon both the duration, in years, of an individual's hypertension, and how elevated the individual's blood pressure has been.

Diet, Cholesterol, and ObesityCardiovascular disease can be directly related to diet, serum cholesterol and lipid (fats) levels and obesity. Genet-ics can be a factor in a person's serum cholesterol and lipid levels. Some indi-viduals have inherited conditions that cause their serum cholesterol and lipid levels to be abnormally high despite a prudent diet. Most of these people will need medication to control their abnormally high levels. The vast ma-jority of individuals who have elevat-ed serum cholesterol and lipid levels, however, eat diets high in cholesterol and saturated fats. These individuals may be able to decrease their levels with better dietary habits alone; some of them may require drug therapy in addition to a change in diet.

Currently, nearly one in every three American adults is obese (4). Not only is obesity linked to cardiovascular disease, but it also predisposes an individual to diabetes mellitus, which is in itself a risk factor for cardiovascular disease.

Sedentary LifestylesUnfortunately, a low level of regular physi-cal activity is the norm in our society. Most jobs in an industrialized country require little, if any, physical exertion, and discre-tionary recreational activity is generally of a sedentary nature. In the United States, more than half of the adult population ad-mits to performing little or no leisure-time physical activity. Despite the great push for an increase in physical fitness and the success of growth industries like health clubs and exercise equipment manufac-turers, we remain a nation predominantly composed of couch potatoes.

A sedentary lifestyle appears to dou-ble the risk of cardiovascular disease when compared to that of more active individuals. One study showed at least a fivefold increase in cardiovascular risk in individuals with a low level of cardio respiratory fitness compared to those who had a high level of cardio respira-tory fitness(5). Most studies, however, have shown that a moderate increase in leisure-time physical activity - i.e., regu-lar exercise - pays great dividends when it comes to prevention of cardiovascu-lar disease. The biggest decrease in risk for cardiovascular disease is seen when comparing the least active individuals to those who are moderately active.

3.1.6

3.1.7



Your Diving FitnessSo how does all of this apply to the average diver?

Diving is an activity that requires at least a modest amount of physical exertion. Under emergency conditions, diving can potentially require a large amount of strenuous ac-tivity for at least a brief period of time.

While it's not necessary that all recreational divers become marathon runners or be able to pass the physical fitness test for training as a Navy SEAL, it certainly pays to be fit. It is in each diver's own best interest to:

• maintain a regular exercise regimen;• eat a diet low in salt, cholesterol and saturated fat;• abstain from smoking or the use of other tobacco products; and• have regular medical evaluations, with periodic measurements of blood

pressure and serum cholesterol levels in consultation with your healthcare provider.

Older individuals and those who have pre-existing risk factors for cardiovascular disease will need more frequent and in-depth medical evaluations. Specialized tests, such as heart monitoring while walking on a treadmill, may be required in some cases. See your doctor regularly to keep measurable track of your health.

Does pre-existing cardiovascular disease mean that an individual cannot partici-pate in recreational diving safely? Not necessarily. Most physicians who provide medical care to divers agree on these facts: adults with high blood pressure con-trolled with medication can safely continue to dive; and divers who have under-gone coronary bypass surgery may be able to dive safely after a period of recovery and rehabilitation. This group of divers must be free of symptoms of coronary heart disease and demonstrate a high level of exercise tolerance. Additionally, their deci-sion to return to diving must be made in consultation with a cardiologist.

Diving can take place in areas remote from medical care and even farther from major medical centres that have cardiac care units. Take control of those factors that influence your health status and modify them so that you can continue to safe-ly enjoy diving for as many years as you can.

3.1.8


References

European Resuscitation Council Guidelines for Resuscitation 2010, Resuscitation (2010)

Cardiovascular Disease and Diving articles:1. American Heart Association. 1998 Heart and Stroke Statistical Update. Dallas, TX: American Heart

Association, 1997.2. Kuczmarski RJ, et al. Increasing Prevalence of Overweight Among U.S. Adults. The National Health

and Nutrition Examination Surveys 1960- 1991. Journal of the AMA 272: 205-211, 1994.3. Caruso J., et. al. Fatalities Related to Cardiovascular Disease in the Recreational Diving Population.

Undersea and Hyperbaric Medicine 24 (supp): 26, 1997.4. Rauramaa R and Leon A. Physical Activity and Risk of Cardiovascular Disease in Middle-Aged

Individuals. Sports Medicine 22: 65-69, 1996.5. Blair SN. Physical Activity, Physical Fitness, and Health. Res Q Exerc Sport 64: 365-376, 1993.


Founded in 1980, DAN is an interna-tional, non-profit dive safety organisa-tion, committed to improving diving safety and to conducting dive research.

IDAN (International DAN) with its head-quarters in the USA and affiliates in Southeast Asia-Pacific, Japan, Southern Africa and Europe can assist you in the unlikely event of a scuba diving acci-dent or injury.

DAN also consults with the emergency medical professionals who continue care after your initial first aid.

If you suspect you've been injured while scuba diving, you can call the DAN Div-ing Emergency Hotline. DAN provides this service to the diving community 24 hours a day, 365 days a year to assist and help arrange for evaluation and treat-ment of injured divers. Whenever you need help, DAN is there for you.

DAN also works to prevent diving inju-ries and accidents. If you have a ques-tion concerning diving medicine, dive safety, fitness for diving or for a referral to a physician knowledgeable in diving medicine, you can call the DAN Dive Safety and Medical Information Line.

DAN also conducts research on scuba diving such as the DAN Diving Safety Laboratory and looking into how flying after diving and various environmental and physiological conditions may affect diver health.

Another way DAN improves dive safety is through training and education. DAN has developed an Automated External Defibrillator programme, oxygen first aid programmes and related oxygen delivery equipment to promote the ben-efits of emergency oxygen first aid for in-jured divers. DAN also offers training pro-grammes for physicians and emergency medical services personnel.

DAN provides these valuable services to the entire dive community because of the support of the world's largest as-sociation of recreational divers, the DAN membership. For an annual fee, DAN members receive many valuable ben-efits including dive accident insurance, Alert Diver, diving's leading safety maga-zine; DAN Travel Assist, access to poten-tial evacuation in a medical emergency when you travel, and others.

DAN is Your Dive Safety Association!

Divers Alert Network

DAN Shop

A sea of products is only a click away...

DAN Shop


Review Questions

Section 1: Section 2:

1. heart disease and electric shock

2. All

3. survival

4. Early access to EMS system, Early CPR, Early Defibrillation and Early advanced Life Support

5. a, c and d

1. scene safety

2. c

3. dry

4. left – breast

5. False

6. True

7. a-b-c

8. a-b-c


Automated External Defibrillation Course Evaluation

Congratulations on completing your DAN AED Provider Course!To help us improve this programme, please complete and return this questionnaire.Safe Diving!

Sincerely,Guy ThomasDAN Europe Director of Training

Strongly Agree: 5Agree: 4Neutral: 3Disagree: 2Strongly Disagree: 1

1. The course met my expectations. 5 4 3 2 12. The course was taught in a relaxed, positive manner. 5 4 3 2 13. The course was fun. 5 4 3 2 14. The instructor clearly understood the material. 5 4 3 2 15. I feel confident in providing care with an AED. 5 4 3 2 16. Did you learn and practise these skills? :

Scene Safety Assessment Yes / No / UnsureInitial Assessment with BLS Yes / No / UnsureThe use of supplemental Oxygen Yes / No / UnsureProviding care with an AED Yes / No / UnsureAED equipment maintenance Yes / No / UnsureEmergency Assistance Plan Yes / No / Unsure

7. How many hours was your course? ________________8. Course Date: ________________________9. Overall quality of the course ___________________ (1 Low – 10 High)

10. Instructor’s name: __________________________________________11. Your name (optional): _______________________________________12. Comments or suggestions: ________________________________________

__________________________________________________________________________________________________________________

Please copy this form and return it to your DAN Instructor or to:DAN Southern Africa Private Bag X197, Halfway House, 1685AN Building, Rosen Office Park - Cnr Invicta & Third Roads Halway Gardens, MidrandTel: +27 11 266 4900 - Fax: +27 11 312 0054 - Email: [email protected]


Notes:

DAN Basic Life Support iii

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