Too many Scuba incidents – Stress, and how to deal with it.

The background

I cannot explain why, but it seems as though more recently there appears to be a wave of scuba diving deaths or incidents that I am being made aware of. Maybe, it’s just a coincidence that it happens to be people within my social networks sharing this information, or maybe with the continued growth of social media has made it easier to have access or exposure to this information?! I don’t know. Either way, the incidents have come to my attention as of late and to me its something that cannot be ignored.

I am not a detective and I do not want to even open the door to try to suggest what has been the cause of such incidents but the interesting common denominator with the majority of these incidents is that the cause of death remains unknown. The diver has failed to surface. When I do hear of such incidents it does prompt me to examine and share with the diving community one topic that is simply impossible to ignore, and I can assure you with no doubt, that each diver that has failed to rejoin us for sure experienced this on their last fatal dive. Stress.

The problem

Stress is an emotion characterized by an unpleasant state of inner turmoil. It is a normal human emotion we all experience when we face threatening or difficult situations. Stress is not the same as fear, which is a response to a real or perceived immediate threat, whereas stress is the expectation of future threat. Associated with the secretion of adrenalin, stress can help us avoid dangerous situations or get out of them. It can make us alert and it can spur us to deal with a threat or other problem and not simply avoiding it (i.e., the “fight or flight” reaction). However, if feelings of foreboding become too strong or last too long, they can hold us back from many normal activities and have debilitating outcomes.

A more intense form of stress is panic, a sudden, unexpected but powerful surge of th-4fear. Panic can cause a wholesale flight from the immediate situation, a reaction that is especially dangerous for scuba divers. A diver who experiences panic at depth is subject to near-drowning, lung over-expansion injuries and death. Panic attacks are extremely dangerous under water, and sometimes its difficult to know what triggers them.

Out of a millions of certified scuba divers, a percentage of recreational scuba divers die each year, but little is known about the precipitating events for many of these deaths. A coroner’s report of “drowning” tells us nothing about what led to, or caused, a divers death. Reports by DAN (Divers Alert Network) and other agencies into scuba diving accidents state that:

“Researchers in diving accidents implicate panic, as a response to stress or anxiety as the major cause of diving fatalities”

th-2

In Medical Examination of Sport Scuba Divers (1998), Alfred Bove states:

“Panic, or ineffective behaviour in the emergency situation when fear is present, is the single biggest killer of sports divers”.

th-3

In 1998 the Recreational Scuba Training Council (RSTC) guideline for the Recreational Scuba Divers physical examination listed “a history of panic disorder” as an absolute contradiction to scuba diving.

However, we must be very clear that there is no way to determine that panic in accidents does result in fatalities, this is merely an assumption based on knowledge of the psychological and behavioural responses that people make to stress. What we do know is that many people feel stress before a dive especially when they are starting out on their scuba diving journey. It is completely understandable as it is a new alien world that is being explored. Beginners don’t know what it is going to feel like underwater or if they will enjoy it. In abnormal situations, stress is manifested by apprehension and dread, though it sometimes cannot be attached to a clearly identifiable stimulus. This stressful state usually occurs in response to a mishap, such as a dive mask flooding with water. This may cause the diver to panic unnecessarily and behave irrationally. The essential feature of a panic attack is a period of intense fear that is accompanied by a sense of imminent danger and an urge to escape, or a desire to flee from wherever the attack is coming from. An
expected result of a diver having a panic attack would be that the divers breathing rate increases, there by resulting in decreased efficiency or oxygen exchange, and a feeling of suffocation ensues. The diver would then typically try to make a rapid ascent to the surface or departure from a certain location or frantically grabs for air supplies and lack of concern for the safety of others.

th

Another way that panic can show itself is what we call Passive panic. These divers are perceived as calm, they will sink, and perish without a call for help. The buddies of these divers thought their associates were non-stressed, and normal. Recognizing this form of panic is very difficult, the victims show no outward signs of any difficulty, but most will have “blank eyes”. Underwater they may lose their regulator and not try to replace it. They will not try to save themselves. Typically a passive victim will seem confused, or vague and then slip underwater. It is the divers total inability to look after themselves and willingness to sink that appears in most case studies.

Either way the panic manifests itself it arises when individuals lack a solution to a critical problem. Sometimes, experienced divers with hundreds of logged dives also experience panic for outwardly no clear reason. The panic most likely occurs because divers lose sight of familiar objects, become disoriented and experience a form of sensory deprivation. The likelihood of a victim of panic coping with any situation is slim to none. In the study of divers death, many still had the weight belt still in place, mouthpiece had been removed, buoyancy compensators were not inflated, and air was still in the tank. This all suggest panic.

One training goal of all scuba diving agencies at all diving levels is to provide the diver with these “solutions” which should become automatic behaviours.

The factors of stress and what to look out for.

Physical Causes of Stress:

Overloading

Sensory Deprivation

Time Pressure

Equipment

Cold Water

Poor Fitness/Swimming Ability

Strong Currents, Waves, Obstructions

Dangerous Marine Life

Psychological Causes of Stress:

Peer Pressure

Social Evaluation

Ego Threat

Fear of the Unknown

Fear of Evaluation

Pre-Dive Physiological Signs:

Increased Heart Rate

Rapid Respiration

Muscle Tension

Frequent Urination

Increased Perspiration

Voice Changes

Decrease in Skin Temperature

Pre-Dive Behavioral Signs:

Introversion

Mental Errors

Forgetfulness

Extreme Cockiness

Irritability

In-Water Symptoms:

Rapid Respiration

The “Wide-Eyed” Look

Inefficient Swimming

Clinging and Clambering

Fixation and Perceptual Narrowing

Sudden Surfacing

High Treading/Trashing

Equipment Rejection

The studies

Many studies have been conducted to examine divers with a history of panic attacks and what were their in water responses. Similarly, reports have been conducted with random scuba diving populations to examine if a panic attack has ever occurred and what the divers response was. This type of panic survey has quite interesting implications on diver training. From these studies and what I can read and interpret are some general conclusions:

  1. Generally the data collected by these various studies would suggest that training of how to deal with emergency situations is largely effective. There was a high percentage of panicking divers who stated that they did remember their training in the emergency situation and it enable them to deal with the situation.
  1. All divers benefit from repetitive skill practise. The more familiar divers are with skills, the more likely they are to respond appropriately to panic. Repeated practice in confined water, including spontaneous drills, raises the response availability levels.

SSI_LOGO_Repetition_RGB_png

  1. Student divers who show more elevated levels of stress and anxiety may be more prone to panic. This may be clear if they show stress when dealing with a new skill. These individuals benefit greatly from repetition, through though the practise required may be higher than for other individuals.
  1. Studies would also suggest that women are much more likely to recognise and ask for help than men in a stressful situation. I am not sure why, but I guess that cultural influence is probably a good speculation. Male self-reliance is quite high in most cultures, asking for help may threaten their self-esteem, or men may be conditioned from a young age to not seek out assistance?! Emphasising diving as a team activity maybe help deal with these gender differences and enable men to be more receptive to assistance and may help to offset self-esteem issues.

Prevention techniques

 Training

Professional training builds your diving confidence, nobody can argue this point. Years of research and tried and tested techniques have gone into the created of today’s scuba diving courses. Modern scuba diving training has been specifically designed to ease stress and slowly build on skills to a point where divers are ready to go out into open water. Organizations, such as SSI, have skills and procedures that divers must learn in sequence – these standards are adhered to by SSI Instructors worldwide. Studying theory, watching videos and learning skills in the pool is followed by practicing in the sea with your instructor. This allows you to slowly develop at your own pace – only progressing when you are comfortable with each section.

This sequencing of training not only applies to the recreational diving world but also to those more experienced divers who are looking to extend their diving either to greater depths or to involve mandatory decompression. For these divers, their basic diving skills should be habitual, but more importantly they are now going to enter a world where sometimes to “go up” is simply not an option. Decompression diving, throws into the equation even more potential stress situations that need to be trained for and managed well.

Stress & Rescue Diver Course

Scuba divers describe the SSI Stress & Rescue Diver course as the most challenging, yet most rewarding course they’ve ever taken. Why? Because you learn to prevent and manage problems in the water, and become more confident in your skills as a diver, knowing that you can help others if needed. Through the course you will learn accident prevention, as well as how to handle problem situations is they occur. The programme is about avoiding, recognizing and solving problems on the surface and underwater.

The SSI Stress and Rescue course prepares you to deal with dive emergencies, minor and major, using a variety of techniques. Through knowledge development and rescue exercises, you learn what to look for and how to respond. During rescue scenarios, you put into practice your knowledge and skills.

Course Content:Diver Stress & Rescue

  • What Is Stress?
  • Stress In Diving: Causes And Prevention
  • Detecting And Dealing With Stress
  • Accident Management
  • Skills Needed To Deal With Panic And Rescues
  • Conditions That Complicate Rescues

Equipment familiarity

During scuba diving training, divers learn how to set up, adjust, check, and put on their equipment. Understanding how your equipment works will give you added confidence and reduce stress. Making sure everything is fitted correctly and securely, with the help of your instructor or buddy, is very important. One of the most important factors to think about when looking at equipment is to make sure that the type of equipment that you are wearing is suitable for the diving environment but most importantly making sure that you have the correct training to be able to use all the equipment in an efficient, habitual automatic way.

Confined Water Practice

This is probably the area of scuba diving at all levels that is simply overlooked. The majority of certified divers only going back into a confined water environment when making a new course and the shallow water skills being a mandatory part of the new course. As I mentioned earlier, as a diver learning to scuba dive their training is performance-based, and they have plenty of time to learn and practice scuba diving skills in the pool before heading out to the open water. Just have a think to yourselves honestly, when was the last time you personally made a review of all scuba diving skills and I mean more than can you clear a mask!

Relaxation and Visual rehearsal

All divers of all levels should begin their dive feeling relaxed and calm. Try not be rushed to get ready, give yourself time to go through the dive plan in your mind with your buddy to make sure you are both clear of the techniques, emergency procedures, entering and exiting methods and generally the diving route. At the start of the dive aim to become relaxed with slow, deep breathing and allow yourself time to get to get orientated to being underwater by pausing after your descent. Take an additional moment in the shallow waters to regulate your breathing. The key point is understanding that breath control and relaxation go hand-in-hand.  Check your equipment and computer, and to signal to your buddy that everything is OK. To not rush and do not be rushed by others. When you rush, you create stress and may not follow the procedures you have been taught. Similarly, don’t rush around underwater – take time to appreciate what nature has created and enjoy the full experience of breathing underwater. Having a good level of calmness will aid in control of stress levels in the water. Divers who also learn the “Calming Response” in Stress and rescue courses, learn a technique which involves stomach breathing. The calming response is a fast and effective way of improving relaxation and performance.  Scuba divers, using this technique, can significantly increase breath control and relaxation within 5 – 10 breaths.

Diving discipline

I have addressed the issue of training and that comfort through repetition of skills is essential in creating automatic habitual responses. However, as divers consider themselves to become more experienced a certain degree of complacency could become evident. This complacency to me is more of an issue than the novice diver with more limited experience. Dare I say it a sense of arrogance surrounds this type of diver and the perceived assumption that “it will never happen to me”. This type of diver no longer considers the underwater world to be a hazardous environment and as such may lack respect for the potential hostile conditions that scuba diving situation can present. Diving preparation falls to a minimal level, equipment is not maintained to an acceptable standard, and recommended diving guidelines no longer apply to them.

Don’t let yourself fall into this category. Have discipline, keep up to date with current training developments, equipment advances, stay mentally and physically active, keep the respect for the underwater world, keep your skills refreshed, plan a dive and dive the plan, and finally leave the ego at home!

Summary

The fact of the matter is that Scuba Diving has inherent risks that simply cannot be removed. However, though the techniques outlined above we can aim to make ourselves as divers as prepared as possible for the activity. Similarly, stress is an emotional factor that also cannot be eliminated from the human psychology. However, there are ways in which we can have better control on stress, awareness of where, when and how it can occur can enable us to keep a good handle on it.

The underwater world can be as unpredictable as it is amazing, this it what keeps drawing us back to it.

Dive safe everybody.

Cat Braun

Tekstreme Diving Manager & Owner

SSI Recreational & Technical Instructor Trainer

cat@tekstremediving.com

http://www.tekstremediving.com

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s