Formulating an Emergency Action Plan

When formulating an Emergency Action Plan many factors should be considered. While it is impossible to anticipate all emergencies, prior planning and proper training are key to dealing with emergency situations. Personnel must act quickly and effectively to minimize injury and/or prevent death. The following guidelines provide a planning tool which, when used properly, will allow an Emergency Action Plan to be developed and in place prior to the start of diving activities.

Emergency Numbers and Information

* Number of EMS and nearest hospital phone and location
* Location and contact information for nearest recompression chamber
* Number of poison control
* DAN emergency number
* Emergency contact information for divers

Equipment Requirements at Location

* Oxygen kit
* First Aid kit
* Pen and paper
* Forms
* Lines for search/recovery
* Backboard, stretcher, etc.
* Communications equipment (VHF, cellular phone, pay phone, CB radio, etc.)
* Flares and signaling devices
* Additional site specific equipment

Personnel Considerations

* Team members backgrounds and personalities
* Who will be in charge of what?

Site considerations

* Marine life
* Entrapments or entanglements
* Physical Hazards
* Depth
* Currents

Action Plan

* Emergency Recognition / Activation of Emergency Action Plan
* How to recall divers and alert personnel
* Search for and recover injured / missing diver
* Spotting Team
* Search and Recovery Team
* Individual to get help
* In-water evaluation and response (airway & breathing)
* Transport to platform or beach
* Extrication from water
* Evaluation and ABCD's
* Activation of EMS (ambulance, Coast Guard. etc.)
* Appropriate first aid (CPR, Oxygen, Shock treatment, etc.)
* Gather information (diver, buddy, equipment, observer)
* Evacuation procedures
* Evacuation mode/route
* Call DAN if appropriate
* Provide info and accompany EMS (inform them compressed gas was used)
* Follow up and reporting procedures

Helicopter Evacuation Procedures

Each helicopter evacuation is different, each one presents its own problems, but knowing what to expect and the procedures to follow can save time, effort, and perhaps a life.

* If your boat is unable to provide the required frequency, work via another
* Maintain speed of 10 to 15 knots, do not slow down or stop
* Maintain course into wind about 20 degrees on port bow
* Put all antennas down if possible, without losing communications
* Secure all loose objects on/or around decks
* Always let the lifting device touch the boat before handling it
* Place lift jacket on patient
* Tie patient in basket, face up
* Provide as much information as you can about patient (casevac form)
* Ensure flight crew is instructed on medical procedures for diving accidents
* Ensure flight crew delivers victim to hyperbaric chamber
* If patient dies, inform flight crew so that they take no unnecessary risks

Obviously, a dive accident plan can vary substantially from site to site. Regardless of the site, the emergency accident plan and contingency plans should be formulated and made clear to the dive team. It often helps to visualize a worst case scenario. On-site accident drills are recommended to illustrate roles, required actions and potential problems.

Risk assessment - what's it all about?

Service providers are responsible for ensuring that before the start of any diving activity, a suitable generic risk assessment has been prepared. Generic risks are those that we have fore knowledge of and can therefore put control measures in place in advance of the activity. These generic risk assessments should be supplemented with an on site risk assessment immediately before the dive, detailing any previously unforeseen hazards and the special precautions or procedures necessary to reduce the risks; as well as re-evaluating those on the generic risk assessment.

Differences between a 'hazard' and a 'risk':
A hazard is anything with the potential to cause harm. A risk is defined as the liklihood that someone or something would be harmed by the hazard.

Hazards and risks should be continuously monitored during any dive or diving related activity. Dive Leaders should be prepared to put any contingency plans into place at any point during the dive.

A Risk Assessment is nothing more than a common sense approach to identifying significant hazards; who or what is likely to be affected by those hazards; the risks associated with those hazards and what measures you will take to control the risks thereby reducing the harm to anyone or anything during any dive or diver training operation, and then recording what you have done. You will need to review the assessment periodically or whenever there is significant change. The important thing to decide is whether an identified hazard is significant, and whether you can ensure the risk of harm is low or negligible before embarking on your dive.

Risk assessment is already inherent in the way divers go about organising their diving and training through careful dive preparation and planning. The consideration of risk inherent in diver training and supervised dives is already paramount in all diver training organisations' course contents, standards and procedures.
A Risk Assessment is simply a way of recording the significant hazards and what measures you will take to reduce the risk of harm on each and every dive. Don't be over complicated.

Checking for hazards is common sense. In taking action, ask yourself these two questions:

Can I get rid of the hazard altogether? If not, how can I control the risks so that harm is unlikely?

For example:

Risk of: Cold water
Hazard: Hypothermia
Risk control measures: Choose appropriate, well fitting exposure protection in good order; reduce dive time; monitor student divers carefully for early signs of cold; brief student divers on appropriate signals to indicate chill; prepare to exit water early if necessary; have warm clothing and shelter available at the site.

Diving is inherently a hazardous activity; however, the known risks are already minimised to some degree by adherence to your diver training organisations' standards and procedures, e.g. the likelihood of a diver having a mask squeeze is minimised as mask equalisation techniques are taught to all divers in the earliest stages of training. This is therefore no longer a significant hazard as the control measure is in place whilst adhering to your diver training organisations' course contents, standards and procedures.

For Angeliki

A recent visit to Kalymnos inspired me to write this story and dedicate it to the wife of my dear friend Alex, on the occassion of her birthday.

‘Greeks and the sea interpenetrate’, the Greek saying goes; and from ancient times young men of the Dodecanese have penetrated the sea in search of natural sponges 'the golden fleece of the sea'.

Until the 1860’s the Greek sponge divers used the ancient and proud technique of 'naked diving’. Today it's known as ‘breath-hold diving’.
Wearing only a net bag slung around his waist, and holding a flat marble stone of 15 Kgs in weight, the diver would shoot down an inclined plane jutting from the side of the boat into the water. He would then plummet to a depth of 70 meters, using the stone as a rudder to steer through his descent. Called a ‘bell stone’ on the island of Symi and a ‘trigger stone’ on the island of Kalymnos because of its function (it triggered the dive), the diving stone was a prized possession handed down from father to son.
The stone had a hole in one rounded end where a line was attached to the boat. On the bottom, if successful, a naked diver could gather one or two sponges in his net bag before tugging on the line, signalling he had to be pulled back to air. Like a sea bird, he would plunge and rise up through a twelve-hour working day, taking neither food nor water, apart from a little bread and coffee at daybreak.

In 1913, a naked diver from Symi rescued the lost anchor of the ‘Regina Margherita’, an Italian warship on her maiden voyage. He dove to a depth of 80 meters on a single breath of air and tied a rope around the anchor. Records show the dive as 3’35”.

In 1863 the Industrial Revolution arrived in the Dodecanese and brought with it swift and huge prosperity won at too terrible a price. The deep-sea diving suit was introduced into the sponge diving industry, and first on the island of Symi. Ironically, the suit - which the divers swiftly came to call ‘Satan’s machine’ - was introduced at a place of incomparable beauty, Symi’s harbour, perhaps being the most stunning in all of Greece.

The new suit allowed the diver to see, to remain underwater - it seemed indefinitely, and to descend to previously unobtainable depths. Needless to say, it increased the diver’s productivity one hundred-fold. As the new deep-diving suits, the ‘skafandra’ came into wide use, casualties mounted in the sponge-fishing islands. Between 1866 and 1895, on the island of Kalymnos alone, 800 young men died of the bends and 200 more were paralysed!

The Industrial Revolution had created an ever growing demand for soft and luxurious sponges for the great cities of Western Europe. Between 1880 and 1890, Symi was the wealthiest port in all the Mediterranean. In a single season, a merchant captain on Symi could earn an entire fortune, and the divers also shared in the bounty. A diver could earn two and half times in six months what a man of similar education could earn in a year.
It was the Golden Age of sponge fishing. All rested on a foundation of ever increasing demand and the increasing sponge yield that came with the ‘skafandra’- bigger boats, better pumps, and with the industrial organisation that now was brought to bear on the sponge fishing industry.
Each spring, in April and May, 300 sponge boats set sail from Kalymnos alone for the six month sponge fishing season that took divers along the coast of North Africa, from Alexandria to Benghazi. And the Kalymnian fleet was joined at sea by large sponge fishing fleets from other Dodecanese islands.
With the increased sponge yield came the destruction of the sponge beds-the harvesting exceeding the natural rate of re-growth. A vicious economic race had been set in motion-merchants demanded more sponges of the divers, and the divers demanded more of themselves in order to keep pace with the growing needs of a plentiful age that supplied silks and satins, Italian marble, French furniture, family portraits and exotic foodstuffs.

The known sponge beds thinned or were wiped out entirely. There was but one way, and that was the way down! Down beyond 50 m, down beyond 70 where even the Aegean daylight grows dim and faint, down to the darkness that their new diving suits made possible for them. But their diving suits were not made for 70m - they were designed for 30!
The awful stories abound: diving boats set sail from Kalymnos right after the joy of Greek Easter with 20 divers on board and returned in the autumn with 10; or left Kalymnos in the spring with 10 divers and returne with none.
One Sunday in May 1895, the news came early that season of many deaths, the women of Kalymnos spontaneously performed the anathema against all merchant captains as women poured out from churches all over the island. Violent protests against the ‘skafandra’ took place in Symi and Kalymnos, sometimes led by women. Intellectuals and theologians arrayed themselves against the merchants and the captains. Bans of fleeting duration were issued, one lasting two years. On the island of Symi the sponge industry had become known as ‘The tyranny’. When the sponge fleet arrived home in Symi in October - after been gone for six months - the women would race to the shore to greet the returning fleet; in solidarity all of the women dressed in black, not knowing who among them would be widows.

Since high casualty rates continued until the 70’s - long after divers knew about proper diving techniques - one often asks the question ‘why’?
It all had to do with a prepayment system, which created the pressure to dive with dangerous disregard to safety. Since the divers may never return, they could command 100 per cent of their six months’ wages in advance of sailing. Since so much money had exchanged hands, divers were under enormous pressure (both self imposed and by captains who now owned them to harvest enough sponge) to match the high prepayment they had received.

We know the causes - the list includes poor equipment, ignorance of proper diving techniques, greed, and the truth that these beautiful rock strewn islands had only the sea to turn to and what the sea so reluctantly gave up.

Emergency Contact Numbers & Hyperbaric Chambers

Emergency numbers

Ambulance 166
Coastguard 108
European Emergency Service 112
Hospitals on Duty 1434
Poison Control Center (Athens) 2107793777
Police 100
Tourist Police 171

Hyperbaric Chambers

Hyperbaric Medical Center (Athens) 2103462898
Kalymnos Chamber 2243061900
Metropolitan Hospital (Piraeus) 2104809337
Naval Hospital (Athens) 2107216166
Souda Naval Base (Crete) 2821089307
Thessaloniki Chamber 2310493407

What about restrictions regarding recreational scuba diving in Greece?

The new recreational scuba diving law now permits diving everywhere in Greece, except in the following instances:

• diving in shipping lanes or anchorages

• areas where naval and/or armed forces carry out exercises or other activities

• areas where hired motorboats can travel 100 meters or less from their starting point

• areas where prohibitions have been imposed by legislation that designates marine areas as protected, or by the administrative and operational regulations or plans of competent administrative authorities

• where there are underwater cables or systems installed by utility companies

• wherever the Coastguard Authority, in a duly justified decision, imposes prohibitions for reasons of safety of ships or personnel

• recreational dives, where not conducted under the services of a Recreational Services Diving Provider, are prohibited from one hour after sunset and up to one hour before sunrise

• scuba diving is prohibited to persons who do not have a certification recognised by an Organisation under article 3 and not under the services of a Recreational Diving Service Provider.
Organisations currently recognised include: ANDI, PADI, IANTD, The Greek Diving Federation, NAUI & SSI

Scuba divers are also forbidden to:

• fish with a spear gun or other means; collect, disturb or destroy individual members of micro-flora and micro-fauna, flora and fauna or commit any acts which might alter or corrupt ecological interaction in the eco-system of the area

• carry underwater fishing equipment or fish or other animal or vegetable marine organisms on a ship or vessel which accompanies them

• haul up, transport or photograph artefacts of archaeological or other value found in the deep

• take photographs or videos in areas where diving is prohibited unless there is written permission from the competent ministry

• dive without being accompanied by another diver

• all divers are to inform the competent Coastguard Authority immediately and by all possible means if they locate objects of archaeological or police interest or shipwrecks

• flag Alpha as described in Chapter 11 of the International 1969 Signals Code, or the internationally recognised diving flag (red with a diagonal white line) is to be flown from the diver’s boat

• divers who venture further than a horizontal distance of 50 meters from the boat which is accompanying them, or who dive from the shore, are obliged to display an orange-coloured float on the surface, with the special sign or internationally recognised flag mentioned in the previous paragraph and all vessels are to remain more than 100 meters from the location of the special sign or internationally recognised flag

Recreational scuba 'service providers' and what they offer

Formerly refered to as dive schools or resorts, a service provider is a professional scuba educator who (1) is a registered business (2) has been audited by an auditing body and (3) has been licensed by the local coastguard authority (via the Ministry of Merchant Marine) to offer one or more, or all of the following services:

Organised and Guided Diving
Equipment Rentals
Air-fill Station