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DAn europe news - organo ufficiale del Divers Alert network europe Periodico trimestrale - Aut. trib. Pescara n. 19/91 del 4/2/94 - Anno 2012 - n.1<br />
arter 2012)<br />
Alert Diver<br />
Digital Magazine<br />
PsychologicAl<br />
reActions AnD scubA<br />
<strong>Diving</strong><br />
Description of a Treatment<br />
The Pleasure of safeTy<br />
Wellness and Underwater<br />
Activities<br />
in the<br />
chAmber<br />
How does a 60<br />
meter dive on air<br />
really feel?<br />
EUROPEAN EDITION<br />
1 /2012<br />
# 47<br />
<strong>Diving</strong><br />
insurAnce:<br />
A Choice or a<br />
Must?<br />
1<br />
Cover photo by Christian Skauge
Write to us!<br />
editor@alertdiver.eu<br />
or mail to:<br />
Editor, Alert Diver magazine<br />
c/o DAN Europe Foundation<br />
Casella Postale 77 - 64026<br />
Roseto degli Abruzzi - Italy<br />
Alert Diver<br />
# 47 (1st Quarter 2012)<br />
Publisher<br />
DAN Europe Foundation<br />
Casella Postale 77<br />
64026 Roseto degli Abruzzi - Italy<br />
Editor-in-chief<br />
Prof. Alessandro Marroni, M.D.<br />
Managing Editor<br />
Dr. Nuccia De Angelis<br />
Editors<br />
Cristian Pellegrini, Laura Marroni,<br />
Franca Di Muzio<br />
Graphic Designer<br />
Laura Volpe<br />
Layout<br />
Jenny Brover, Francesca Di Ferdinando<br />
Contributors to this issue<br />
Annart<br />
Julian Boffa<br />
Francois Burman<br />
Elizabeth Cook<br />
Maria Luisa Gargiulo<br />
David Haas<br />
Rick Layton<br />
Rheana Murray<br />
Massimo Pieri<br />
Bryon Saxton<br />
Christian Skauge<br />
Richard D. Vann<br />
Alert Diver is published quarterly (four times yearly) by DAN Europe Foundation.<br />
Alert Diver is a DAN Europe membership benefit.<br />
Our Translators<br />
Croatian Ivan Ivicevic<br />
Darko Kovacevic<br />
Czech Klement Hartinger<br />
Danish Olav Balslev<br />
Dutch Els Knaapen<br />
English Davide Arnold<br />
Lamagni<br />
Estonian Markko Junolainen<br />
Tuuli Piirsalu<br />
Finnish JP Vuorio<br />
French Gwendolyn Hayden<br />
German Stefanie Staudinger<br />
Greek Viviana Delidaki<br />
Hungarian László Fogarasi<br />
Italian Maria Grazia<br />
Montanucci<br />
Polish Jaroslaw Woch<br />
Portuguese Tiago Fernandes<br />
Slovenian Igor Urh<br />
Spanish Ramon Verdaguer<br />
Swedish Gustaf Lundskog<br />
Turkish Bahar Ozkan<br />
Murat Egi<br />
Inquiries or letters may be edited for clarity and length. All letters will be considered for publication.<br />
Text, illustrations or photographs in Alert Diver may not be reproduced or reprinted without the expressed consent of<br />
DAN Europe Foundation and its authors, artists and photographers.<br />
# 47 (1st Quarter 2012)<br />
3
Contents<br />
Editorial 6<br />
letters to the editor 8<br />
Bulletin Board<br />
the hyperbaric centres of the DAn europe<br />
network – serbia 10<br />
By Nuccia De Angelis<br />
try-diving in malta with DAn team 14<br />
Partnerships 16<br />
Dive shows 2011/2012 18<br />
Prepared Diver<br />
breathless on the bottom 20<br />
DAN Reviews Out-of-Air Accidents and Incidents<br />
By Rick Layton<br />
Medical Line<br />
scuba exercises help stroke survivor recover 26<br />
By Bryon Saxton<br />
Psychological reactions and scuba diving,<br />
description of a treatment 28<br />
By Maria Luisa Gargiulo<br />
Features<br />
<strong>Diving</strong> the uss barometer 36<br />
By Richard Vann<br />
in the chamber 40<br />
By Christian Skauge<br />
“nuts & bolts” 46<br />
Our Program for the Maintenance of Recompression<br />
Chambers<br />
By Francois Burman<br />
14<br />
46<br />
20<br />
10<br />
lobster divers dying in honduras, struck with<br />
paralysis and decompression illness 48<br />
By Rheana Murray<br />
Success Stories<br />
buddy diving and Dcs: 50<br />
an experience among friends<br />
By DAN Europe Staff<br />
DAN Research<br />
the pleasure of safety 52<br />
Wellness & underwater activities in the Maldives<br />
By Cristian Pellegrini<br />
Travel <strong>notes</strong> by Massimo Pieri<br />
A rare and precious contribution for<br />
DAn research 59<br />
By DAN Europe Staff<br />
Curiosities from the Underwater World<br />
underwater Painting, an Aquatic Art 60<br />
By Annart<br />
Insurance Matters<br />
<strong>Diving</strong> insurance: A choice or A must? 62<br />
By Julian Boffa<br />
Sea Stories<br />
mutual respect 68<br />
Do the Guadalupe White Sharks Coexist with Pinnipeds?<br />
By David Haas<br />
turtle islands marine Park 72<br />
By Elizabeth Cook<br />
50<br />
68<br />
72<br />
52<br />
# 47 (1st Quarter 2012)<br />
5
8<br />
Letters to the editor<br />
letters to the editor<br />
Oxygen First Aid for <strong>Scuba</strong><br />
<strong>Diving</strong> Injuries represents<br />
entry-level training to<br />
educate the general diving<br />
(and qualified non-diving)<br />
public to better recognise<br />
possible dive-related<br />
injuries and to provide<br />
emergency oxygen first aid<br />
while activating the local<br />
emergency medical services<br />
(EMS) and / or arranging for<br />
evacuation to the nearest<br />
available medical facility.<br />
More info<br />
about<br />
the course<br />
oxygen First Aid: the big difference<br />
Last January 1st, like each year for the past few ones, I received<br />
a call from my friend Javier to wish me all the best for 2012 and to<br />
notify me he had just became the grandfather of a precious little girl.<br />
His daughter - the little girl’s mother - asked him to give me a call<br />
to notify me the birth of her daughter. She told him: “you must let<br />
Ramon know; if it would not have been for him, you would never had<br />
been able to meet her…”<br />
All started a few years ago… Back then, I was working as the head<br />
of operations of a scuba diving center at the Costa Brava - Girona,<br />
Spain. I had just finished diving with some students and while I<br />
was taking off the gear aboard the center’s boat, I heard somebody<br />
screaming. I looked over and saw a couple on a speed boat who<br />
were holding something that was in the water. I jumped on the<br />
auxiliary boat and went as fast as I could towards them.<br />
When I came near their boat, I saw they were holding the arm of a<br />
person whose body was entirely immersed. They informed me they<br />
found him floating. I seized him quickly and we lifted him on board of<br />
my boat.<br />
He was not breathing and I could not detect his pulse. His eyes<br />
were half open with mydriatic pupils…. I did not know at that point<br />
how long he had been in the water; probably a few hours, because<br />
he still looked good in spite of the lividity of his face… I did not think<br />
twice: instinctively I gave him a few rescue breaths and started CPR<br />
on him. A few minutes passed and I noticed some changes in his<br />
physical appearance. That prompted me to yell at the people aboard<br />
the diving center boat to start quickly preparing the DAN oxygen<br />
equipment, which is a permanent fixture onboard, while I was<br />
heading towards it at full speed.<br />
I gave instructions to the staff on board to call (channel#16 – phone<br />
call 112) for the EMS to be at the harbour urgently. I requested for<br />
someone to come with me and take us to the harbour as fast as<br />
possible. In the meantime, I kept giving the Oxygen First Aid to the<br />
patient, who had not regained spontaneous breathing yet. I kept<br />
alternating chest compressions with ventilations using the oronasal<br />
resuscitation mask connected to a constant oxygen flow. His gaze<br />
was fixed without giving any signs indicating that he was still alive,<br />
except the change in color and some little convulsions. I thought<br />
that maybe all these efforts were in vain or that, in the best of cases,<br />
he would come out alive but he would be a vegetable for the rest of his<br />
life, living in a coma for ever… Nonetheless I decided to count on him<br />
living, as long as I could keep doing what I was doing with every ounce<br />
of my strength. Practicing CPR, together with the terrible stress of the<br />
moment, can be exhausting. Fortunately the trip to the harbour was<br />
short.<br />
When we got there, thanks to the fact that they had been previously<br />
alerted, we found the emergency medical services waiting for us; they<br />
took over caring for the victim. I gave them the little information I had<br />
and mentally said my goodbyes, with the certainty that I would never<br />
see him again.<br />
About 10 days later, I received a phone call. A man’s voice identified<br />
himself as Javier and he told me he was the man I had rescued. He<br />
explained he had come out of a coma and as soon as he could speak,<br />
requested to be told what had happened. He could not remember<br />
anything except he had been practicing apnea at a depth of about -30<br />
meters when he suffered syncope while ascending. The next thing he<br />
remembered was waking up in the hospital. As soon as he was able to<br />
do so, he wanted to thank me personally. He asked if he could come to<br />
visit me with his wife and his two daughters (ages 15 and 16).<br />
It was a very emotional meeting. He mentioned that he practiced<br />
apnea because he thought scuba diving was a very dangerous<br />
activity... needless to say, I made sure to correct his erroneous<br />
conception. He later ended up taking a diving course with me, together<br />
with his older daughter.<br />
As a result of that incident, a very solid friendship was born which we<br />
perpetuate and celebrate, year after year, especially at Christmas.<br />
Javier and his family say that they will be forever grateful to all people<br />
who took part in his miraculous recuperation, without collateral<br />
damages.<br />
As for me, I would like to extend my gratitude to the solid training<br />
that DAN gave me and underline the fact that giving Oxygen First Aid<br />
made, without a doubt, a great difference.<br />
ramon verdaguer<br />
DAn instructor trAiner # 26255<br />
# 47 (1st Quarter 2012) 9
ulletin board<br />
Updates on ongoing projects<br />
The hyperbaric<br />
Centres of the<br />
DaN europe<br />
Network –<br />
serbia<br />
By Nuccia De Angelis<br />
The Hyperbaric Centres DAN Europe relies on in<br />
case of emergency have been chosen around the<br />
world for their outstanding technical specifications,<br />
the training of their medical personnel and 24/7<br />
availability.<br />
We begin this review with Serbia, where Prof.<br />
Alessandro Marroni has recently gone to coordinate<br />
the organisation of the 38th Congress of the<br />
European Underwater and Baromedical Society<br />
(EUBS) and of the 8th DAN Day, which are to take<br />
place simultaneously in Belgrade on September 11-<br />
16 2012.<br />
Serbia has represented an important link between<br />
Eastern and Western Europe. It is situated in the<br />
centre of the Balkan Peninsula, in the southeast<br />
of the European continent. The north of Serbia<br />
borders with Central Europe, but because of its<br />
position and climate, it can be considered for all<br />
intents and purposes a Mediterranean region.<br />
Belgrade, the capital of Serbia, is one of the oldest<br />
cities in Europe. Strategically situated in the point<br />
of confluence of the two Sava and Danube rivers,<br />
it is internationally known as the “Gateway to the<br />
Balkans” and the “Door to Central Europe”.<br />
The three DAN Europe Network hyperbaric centres<br />
managed by the Centre for Hyperbaric Medicine<br />
# 47 (1st Quarter 2012)<br />
www.eubs2012.org/<br />
eubs meeting<br />
& DAn Divers Day<br />
to be held next<br />
september in<br />
belgrade<br />
The 38th Annual Scientific<br />
Meeting of the European<br />
Underwater and Baromedical<br />
Society (EUBS) will take place<br />
in Belgrade (Serbia), from<br />
September 11-16, 2012<br />
We invite you to visit the EUBS<br />
2012 website. There you can<br />
check the preliminary programme<br />
and register for the meeting.<br />
We also invite you to the 8th<br />
DAN DIVERS DAY, a recreational<br />
diving medicine symposium and<br />
a EUBS meeting satellite event.<br />
Participation is free of charge.<br />
are located in Baniza at the Orthopaedic Institute; in<br />
Belgrade, in the department of Histophysiology of the<br />
University Policlinic and in Vrnjacka Banja, in a spa<br />
complex.<br />
Mile Zaric can be considered the deus ex machina of<br />
Serbian Baromedicine. In 1993 he decided to boost<br />
the progress of hyperbaric medicine in his country by<br />
activating multi-seat chambers with the most ample<br />
therapeutic capacity. A mechanical engineer and<br />
owner of plastics industries, the inventor of special<br />
seals and pneumatic lifting systems for which he<br />
holds the patents, Zaric was also an expert diver,<br />
and in that capacity knew of the opportunities offered<br />
by hyperbaric medicine in therapy. This was in the<br />
aftermath of the war, with many wounded people,<br />
also affected by traumas and amputations risking<br />
infections because of the pharmaceutical embargo:<br />
hyperbaric therapy could surely help. Mile Zaric<br />
bought a multi-person Comex chamber and began<br />
his work, more humanitarian than commercial. Then,<br />
in 1994, the collaboration with Dr. Nicola Dekleva<br />
gave a huge push to hyperbaric medicine, when<br />
a symposium was held with attending speakers of<br />
international renown, sharing knowledge with over<br />
400 attending Serbian doctors. In the same year<br />
the first Hyperbaric Centre opened in the Baniza<br />
Orthopaedic Hospital, which in 1996 also gained the<br />
sponsorship of the Health Insurance Fund. From<br />
that moment it was an uphill struggle until 1997, with<br />
the constitution of the Baromedicine School at the<br />
Medicine Faculty of Belgrade University of which<br />
Prof. Alessandro Marroni has been the international<br />
coordinator. Initially, the students of the School,<br />
already graduated and specialised in medicine,<br />
came from Serbia and Montenegro but it aimed<br />
at internationality. Unfortunately, the war abruptly<br />
interrupted the activities of the School which wasn’t<br />
able to start fully functioning until 2007, but this time<br />
with the international characteristics which it aimed<br />
at from the start. The Serbian students have been<br />
joined by ones from Macedonia, Greece, Turkey and<br />
Bulgaria. An international e-learning system is shared<br />
with the University of Stellenbosch in South Africa.<br />
In the meantime, the Baniza Hyperbaric Centre had<br />
been working around the clock, with more than 60<br />
patients a day. A second Centre was starting to prove<br />
necessary, and this was inaugurated in Belgrade<br />
in 2008 in the Histophysiology Department of the<br />
University Policlinic.<br />
11
ulletin board<br />
Updates on ongoing projects<br />
Partnerships<br />
DAN Research & COUSTEAU Divers<br />
The two not-for-profit organisations have joined forces and<br />
actively cooperate in Participative Science projects, where<br />
research on diving physiology and diving medicine meet study<br />
and conservation of the marine environment.<br />
To get involved, or for more info, write to:<br />
dsl@daneurope.org<br />
info@cousteaudivers.org<br />
The Changing Oceans Expedition<br />
DAN Europe is proud to be friends with the Changing Oceans<br />
Expedition, a ten-year adventure through the world’s most<br />
important marine eco-regions, to bring the world the latest<br />
update information on the state of our oceans. DAN has<br />
donated to the friends of the Changing Oceans crew a Doppler<br />
Ultrasound Device and a Dive Data Recorder. These tools will<br />
let them detect and register bubbles moving in the blood vessels<br />
after their dives. The detection of bubbles will be made according<br />
to the DAN DSL (<strong>Diving</strong> Safety Laboratory) standards. The DSL<br />
will collect the data and use these information to update the<br />
Research database.<br />
More info: www.changingoceans.org<br />
Life for Madagascar<br />
DAN supports a Hospital construction project on the<br />
remote island of Nosy Be, Madagascar. The project<br />
is run by not-for-profit organisation Life<br />
for Madagascar. The Hospital will<br />
include a hyperbaric centre.<br />
# 47 (1st Quarter 2012)<br />
Deep Pool in Conflans Saint-Honorine<br />
(Paris area)<br />
DAN and Aquatic Centre in Conflans (Paris area) have recently<br />
signed a partnership agreement based on scientific research.<br />
Under this partnership, divers who are active DAN members, will<br />
benefit from reductions on the admittance prices to the deep pool<br />
(20 metres depth).<br />
• For any dive bought, the second dive is offered for free<br />
• A book of 10 dives costs € 119.50 instead of 150 € (20%<br />
discount)<br />
About the Aquatic Center in Conflans Sainte<br />
Honorine<br />
Since 2001, the aquatic center hosts nearly 20,000 divers<br />
per year, with the only deep pool (20m) in the Paris region.<br />
For more information: www.vert-marine.com<br />
17
ulletin board<br />
Updates on ongoing projects<br />
Dive Shows 2011/2012<br />
Dive 2011 - Birmingham, UK<br />
22-23 October 2011<br />
Dive Show Copehagen<br />
20-22 January 2012<br />
Vildmarksmässan -<br />
Stockholm, Sweden<br />
8 - 11 March 2012<br />
Salon de la Plongée - Paris<br />
13-16 January 2012<br />
Underwater Adventure -<br />
Warsaw, Poland<br />
4-5 February 2012<br />
MATKA - Helsinki, Finland<br />
19-22 January 2012<br />
DAN<br />
Was<br />
There!<br />
Duikvaker - Netherlands<br />
4-5 February 2012<br />
# 47 (1st Quarter 2012)<br />
BOOT - Messe Düsseldorf<br />
21-29 January 2012<br />
Medex - Istambul, Turkey<br />
5-8 April January 2012<br />
London Dive Show 2012<br />
31 March - 1 April 2012<br />
Eudishow 2012 - Milano, Italy<br />
16-19 February 2012<br />
Dive Travel Show - Madrid, Spain<br />
24 - 25 March 2012<br />
Duikshow - Antwerp, Belgium<br />
31 March - 1 April 2012<br />
Cornella Dive Show - Barcelona, Spain<br />
16-18 March 2012<br />
19
Prepared Diver<br />
Breathless<br />
on the Bottom<br />
DaN reviews out-of-air<br />
accidents and Incidents<br />
By Rick Layton<br />
# 47 (1st Quarter 2012)<br />
Years ago a cave diver put something<br />
into perspective for me: You can go<br />
weeks without food, days without water,<br />
but only minutes without air.<br />
That pretty much sums up how critical<br />
it is for us to ensure we have an adequate<br />
air supply - and back-up breathing<br />
capability - before we drop into the<br />
depths.<br />
Whether we’re exploring the dark recesses<br />
of a cave system or roaming a<br />
sunny reef in 20 feet (6 meters) of crystal-clear<br />
water, suddenly running out<br />
of air presents a problem we must address<br />
right away. When divers are unable<br />
to deal successfully with such an<br />
event, the outcome can be fatal. In this<br />
issue, we take a look at some out-of-air<br />
emergencies.<br />
The nature of the problem<br />
The sea can be particularly unforgiving<br />
of divers’ mistakes: sometimes we<br />
don’t get second chances. The diving<br />
world reported 153 fatalities in 2003.<br />
According to the DAN Report on Decompression<br />
Illness, <strong>Diving</strong> Fatalities<br />
and Project Dive Exploration (the 2005<br />
edition, based on 2003 data), loss of<br />
breathing gas supply was a problem in<br />
at least 29 (nearly one-fifth) of those accidents<br />
for 2003.<br />
As the report states, “Among these<br />
were five solo divers who could not get<br />
help. In 15 cases, buddies separated<br />
intentionally or lost contact before running<br />
out of air. In two cases, divers did<br />
not check their gas supplies before<br />
their dives and started diving with nearly<br />
empty tanks.<br />
In one case, the diver used a rebreather<br />
that was so poorly maintained such that<br />
oxygen was not delivered due to a par-<br />
tial obstruction of the supply line. One<br />
diver consumed nearly all of his gas on<br />
the way into a cave.”<br />
This is indication that we can benefit by<br />
considering the prospects of out-of-air<br />
emergencies. Different errors and problems<br />
have left divers in the lurch when<br />
it comes to breathing gas.<br />
Consider the following “Top Ten Traps”<br />
that lead divers to an out-of-air scenario:<br />
1. Distraction; lacking situational (air<br />
supply) awareness<br />
2. Environmental considerations such<br />
as: exceeding planned depth, encountering<br />
currents, cold exposure,<br />
entanglements, and narcosis<br />
3. Regulator malfunction due to poor<br />
maintenance - or none<br />
4. Failures to O-ring, hose and diaphragm<br />
5. Free-flow due to sand, foreign particles<br />
or ice formation<br />
6. Erroneous (or lack of) pressure<br />
gauge readings and alarms<br />
7. Improper rigging of equipment<br />
8. Damage caused by impact, abrasion<br />
or sharp objects<br />
9. Failed mouthpieces<br />
10. Inadequate gas supply or an improper<br />
fill.<br />
A diver is lucky when he receives warning<br />
of an impending breathing gas<br />
problem. A free-flow, visible air leak or<br />
hard-to-breathe regulator may provide<br />
enough warning for a diver to make a<br />
normal ascent to the surface before he<br />
runs out of air completely. It’s quite a<br />
different situation when an attempt to<br />
take a breath is answered with a gulp<br />
of water or nothing at all. All too often,<br />
a diver in that situation makes a rapid<br />
ascent, and the outcome sometimes<br />
isn’t pretty.<br />
21
Prepared Diver<br />
The unsuspecting diver<br />
If you don’t think an out-of-air emergency<br />
can happen to you, think again.<br />
Even a highly qualified and experienced<br />
diver can run into trouble, and if<br />
he isn’t prepared, the price paid can be<br />
high. Such was the case for an experienced<br />
42-year-old technical diver and<br />
dive instructor who made a solo shore<br />
entry so he could test out a rebreather.<br />
According to the DAN report, the diver<br />
ran out of air, and, having no backup<br />
breathing equipment, he made a rapid<br />
ascent to the surface. He was later<br />
found on the bottom, unconscious and<br />
with his mouthpiece out of his mouth.<br />
The cause of death was listed as<br />
“drowning due to air embolism, rapid<br />
ascent and insufficient gas”.<br />
It is unclear from the report precisely<br />
what went wrong on this dive. The diver<br />
may have reasoned that there was little<br />
danger diving alone, that it would<br />
be just a quick dive; or perhaps he reasoned<br />
that his skills greatly exceeded<br />
the demands of the intended dive, and<br />
as such, precautions such as a backup<br />
gas supply or buddy were simply unnecessary.<br />
As this accident illustrates,<br />
we should never overestimate our capabilities<br />
or underestimate the need to<br />
follow established safety protocols.<br />
A fatal distraction?<br />
Our next accident involves an experienced<br />
47-year-old rescue diver who was<br />
making an underwater video on a wreck.<br />
To keep the audio track of his recording<br />
clear, the diver turned off all the alarms<br />
on his dive computer. Throughout the<br />
dive, his buddy was engaged in similar<br />
activity on the other side of the wreck.<br />
The diver descended to a depth of 148<br />
feet (44 meters). Some 16 minutes into<br />
the dive, he realized he was out of air.<br />
He made a rapid ascent up the anchor<br />
line from 140 feet (42 meters) to 60<br />
feet (18 meters). There, the divemaster<br />
tried to assist him.<br />
For some reason, however, the diver<br />
refused to take an alternate air source<br />
and appeared confused. The divemaster<br />
assisted him to the surface. At this<br />
point, he lost consciousness and could<br />
not be revived. The cause of death was<br />
listed as “air embolism due to rapid ascent,<br />
insufficient air.”<br />
After reading this report, we might wonder<br />
if the diver could have avoided the<br />
rapid ascent if he had not disabled the<br />
alarms on his dive computer. He was<br />
most likely focused on filming, and this<br />
may have distracted him from monitoring<br />
his air supply. With ample warning<br />
of low air, the diver might have made<br />
a normal ascent without incident. We’ll<br />
never know for certain, but the incident<br />
reminds us to take advantage of all the<br />
tools available for maintaining situational<br />
awareness when diving.<br />
Planning is essential<br />
When we tackle more demanding dive<br />
environments, it is absolutely essential<br />
to plan our dives carefully and to follow<br />
the safety procedures established so<br />
we can minimize the risks. This is especially<br />
true when it comes to air supply<br />
and diving in overhead environments.<br />
Take the case of the 33-year-old diver<br />
with 10 years’ diving experience. He was<br />
penetrating a deep wreck with a buddy,<br />
and, at some point, the two became<br />
separated. When the diver failed to surface<br />
at the prearranged time, recovery<br />
divers searched for him. Later that day,<br />
# 47 (1st Quarter 2012)<br />
they found the body in the cargo hold of<br />
the ship. His tank was empty. The report<br />
<strong>notes</strong> that he had not used any safety<br />
line for the wreck penetration.<br />
Like the event of the diver disabling his<br />
computer alarm, this accident highlights<br />
the need to follow rigid safety protocols.<br />
When an immediate ascent is not possible<br />
- as in an overhead environment<br />
like this shipwreck - divers must have<br />
adequate air to sort through any emergency<br />
that occurs underwater. Had the<br />
diver planned more carefully, and if he<br />
had used a line to follow out, he may<br />
have exited the wreck before running<br />
out of air.<br />
Air-share skills and<br />
preparedness<br />
Preparedness for diving has many facets.<br />
A diver must be prepared not only<br />
with adequate air, but also with skills,<br />
experience and training equal to the demands<br />
of the planned dive. We all do<br />
well to recognize that unused skills will<br />
soon erode. For the infrequent diver,<br />
that suggests the need to take a little<br />
extra time and effort to sharpen those<br />
skills and verify that all equipment is<br />
“good to go.” Failure to do so surely<br />
tempts fate.<br />
That may have been the case for a<br />
57-year-old open water-certified diver<br />
who had more than 30 years of diving<br />
experience, but who went diving infrequently.<br />
Most of his dives had been<br />
made in fresh water, but on this occasion,<br />
it was a boat dive in the ocean.<br />
The diver and his buddy entered the<br />
water and descended to a depth of<br />
about 80 feet (24 meters). Some 15<br />
minutes later, he signaled to his buddy<br />
that he was out of air, and he pulled his<br />
buddy’s regulator from his mouth.<br />
23
medical line<br />
Psychological reactions and<br />
scuba diving, description of a<br />
treatment<br />
by Dr. Maria Luisa Gargiulo, Psychotherapist Psychologist (1)<br />
28<br />
NOTES<br />
(1) A diver and psychotherapeutic psychologist<br />
for more than 15 years, she lives and<br />
works in Rome as a clinical psychologist<br />
and educator in the diving sector.<br />
(2) Venza, Capodieci, Gargiulo, Lo Verso,<br />
2006<br />
(3) Gargiulo, 2003 b<br />
(4) Capodieci, 2001<br />
(5) Gargiulo, 2011<br />
(6) Gargiulo, 2002<br />
(7) Gargiulo, 2003 a<br />
The psychological aspect of underwater activities is<br />
an important domain (2): scuba diving requires a high<br />
degree of adaptability in behaviour. From the sports<br />
psychology aspect, the practice of diving is characterized<br />
by physical performance of long duration, a<br />
medium level of effort and a necessity for the right<br />
mental equilibrium in activation, concentration and<br />
relaxation.<br />
During open water dives, divers are faced with a variety<br />
of events, their reaction to the various circumstances<br />
therefore constitute a prevailing variable in<br />
the management of a dive.<br />
Reactions to danger and situations of presumed<br />
threat are as important for a diver as technical skills,<br />
like knowing how to handle equipment and how to<br />
plan a dive properly.<br />
Learning to react adequately in situations of tension<br />
or fear is considered truly indispensable, to the extent<br />
that all underwater training courses should teach how<br />
to deal with these emotional states, as hyperbaric<br />
environments do not allow divers to behave as you<br />
would on dry land (3). In fact escape, interrupting a<br />
dive and getting quickly out of the water, are all forms<br />
of behaviour, which if not thoughtfully carried out,<br />
would imperil the health of a diver and sometimes<br />
that of his or her buddies.<br />
Learning to handle progressively higher levels of<br />
stress, whilst maintaining lucidity and control over a<br />
situation is something that comes gradually and requires<br />
patience. It should be developed just like emotional<br />
and behavioural skills, which are strictly connected<br />
to the training of scuba divers (4).<br />
Besides, learning to recognise one’s limits and recognise<br />
one’s feelings (5) allows divers to avoid difficult<br />
situations when not in the best of psychological conditions.<br />
Those who are capable of detecting a temporary<br />
sensation of inefficiency, insecurity or lack of<br />
concentration can decide to avoid a dive, or to plan it<br />
appropriately to their condition (6).<br />
A profound knowledge of oneself and the habit of a<br />
healthy internal dialogue in fact seem the best conditions<br />
to face the small and big tension that diving can<br />
have in store for us (7).<br />
# 47 (1st Quarter 2012) 29
medical line<br />
Psychologists can play an important role in the prevention of risk and in the management<br />
of behaviour affecting diving security. They can help divers solve psychological<br />
problems following traumas, including those connected to underwater<br />
accidents.<br />
<strong>Diving</strong> and stress factors<br />
Stress factors are interpersonal environmental stimuli which require the organism<br />
to adapt from a bio-psycho-social point of view. The way a person reacts to<br />
an event is called adaptation; it includes cognitive strategies, emotional<br />
responses and interpersonal resources. In dives, many variables can concur to<br />
create a stressful underwater situation. These may be environmental events,<br />
equipment failures and the behaviour of other people.<br />
But, besides these situational elements, there are other variables which we could<br />
divide between risk factors and protection factors. They condition divers’ reactions,<br />
affecting the pre-existing sensation of subjective security. This<br />
is also conditioned by elements of terrestrial life which can strongly affect divers’<br />
reactions to unexpected events.<br />
The perception of a danger causes the organism to predispose the activation of a<br />
complex reaction with various outcomes, on the mental and physical plane, managed<br />
by a set of organs and apparatuses which include the nervous, hormones,<br />
endocrines and circulation systems, the muscle structure, sense organs, etc. The<br />
mind contributes acting as an interface between the organism and the environment,<br />
with reactions, emotions, thoughts, etc. This bio-psychic organization is<br />
generically called the Fight or Flight System.<br />
Fear is the emotional, lived aspect of a complex reaction, with specific characteristics<br />
and changes in the mind and body, selected in millennia of evolution,<br />
which the body enacts to best tackle dangers. Automatic reactions, which are<br />
not mediated by learning and conscious reasoning, lead to being able to manage<br />
a situation, distancing the body from the apparent threat, and thus fleeing<br />
as the organism finds attack inconvenient. That helps to explain the reaction of<br />
escaping or the temptation to escape which can sometimes be felt underwater.<br />
Therefore the problem is not that of being scared or alarmed, but of being able to<br />
consciously handle the archaic tendencies connected to this state.<br />
Fear is triggered by activation level (arousal) i.e. the ability to mobilise at an occurrence.<br />
This indicates that certain events are interpreted as being dangerous to<br />
the organism. With training and the addition of new emotional experiences, new<br />
meaning can be added to events, and this can modify our activation level and our<br />
consequent reaction.<br />
30<br />
To feel safe is not the same thing as being effectively safe, but our behaviour<br />
depends most often on the subjective evaluation of safety and danger (8).<br />
Many underwater accidents are linked to behaviour management in the presence<br />
of a danger (real or imaginary).<br />
In particular, a high level of pre-existing anxiety increases the level of alarm with<br />
which the dive is tackled, making it difficult for a person to exercise rational control<br />
and reflect before acting. We can also see how other non-diving variables<br />
condition the way we behave in water. There are aspects of our terrestrial life<br />
which can affect the sensation of safety or vulnerability in diving, if these affect<br />
the general system of certainties in life (9).<br />
A personal predisposition to manage events in an alarmed manner and to feel in<br />
danger can thus generate a background level of anxiety, which poorly disposes<br />
a person to handing a diving experience. In fact, the presence of an anxiety disorder,<br />
especially if badly compensated for, should be at least a transitory reason<br />
for not diving, and it should certainly suggest a need to empower all those mental<br />
capacities which are needed in the management of emotional and mental<br />
states, even through specific training.<br />
In particular, some anxiety disorders are characterised by a fear of losing control,<br />
from a self-appraisal of incapacity in the presence of a threat, and the tendency<br />
to imagine one’s imminent reaction to danger, evoking and concentrating on the<br />
various bodily sensations which are normally connected to a state of arousal.<br />
This mechanism is called anticipatory anxiety, and leads people to try<br />
to control their fear level, which thus increases because the person merely reevokes,<br />
amplifies and dilates their reactions over time, being frightened by what<br />
they ascertain, thus generating a pathogenic loop.<br />
Secretly, many divers have experienced fear during diving, small traumas which<br />
have afterwards generated a difficult psychological situation. This is an ambivalent<br />
sensation that divers are most often ashamed of: on the one hand a person<br />
tries to avoid situations similar to the ones that had frightened them, on the other,<br />
their thoughts continue to be attracted to recollections of sensations or other<br />
fear-generating elements.<br />
Following problematic situations, counselling or psychological rehabilitation sessions<br />
are effective, based on cognitive-behavioural methods such as EMDR (10)<br />
(Eye Movement Desensitization and Reprocessing), a method which in the clini-<br />
NOTES<br />
(8) Aquilar, Del Castello, 1998<br />
(9) Liotti, 2001<br />
(10) Alfieri, 2009<br />
# 47 (1st Quarter 2012) 31
medical line<br />
cal case described I have adapted to a diving scenario.<br />
Such methods are also useful in bouts of Post Traumatic Stress Disorder (11)<br />
(PTSD) or adaptation disorders. (12). These conditions can arise following unpleasant<br />
or stressing diving experiences of various nature, and are described<br />
in the Diagnostic and Statistical Manual of Mental Disorders (13) (DSM IV TR),<br />
which lists and defines disorders according to the criteria adopted by the international<br />
clinical community.<br />
clinical case<br />
The patient is a 25-year old male, whom at the time of the stressful event was<br />
working as an underwater guide, which he’d been doing for about two years.<br />
The man came to me for a psychotherapeutic consultation after about two years<br />
of clinically significant problems, which were heavily affecting his lifestyle.<br />
The main request was help for improvement in the quality of life and health, the<br />
possibility of taking up diving again, even if just recreationally.<br />
The symptoms first appeared at the beginning of a circa 27-metre ascent, just<br />
after leaving the seabed, far enough away from it for it to be out of sight, like the<br />
surface.<br />
The episode was recounted to me and defined as a panic attack, with the loss<br />
of the mask. The main symptoms of the ensuing period recalled to me were a<br />
persistent impossibility to go diving, symptoms of social isolation, anxiety, a depressed<br />
mood. Symptoms of anxiety such as agoraphobia had become consolidated<br />
and increased in the year after the accident, accompanied by a reduction<br />
in social activities and working hours.<br />
It was at that time that the man consulted a psychiatrist with whom he began<br />
a course of pharmacological treatment with Escitalopram 20 mg (14) a day, a<br />
therapy still in course a year later, at the time of the psychotherapy consultation<br />
with me.<br />
32<br />
The symptoms present at the time of my consultation were: difficulty in getting to<br />
sleep, frequent states of anxiety, preoccupation for one’s state of health (forced<br />
breathing), a sense of respiratory constriction; avoidance of highly stressful and<br />
involving situations, especially when connected with evaluation and performance.<br />
The experience of underwater panic had led to a traumatic event<br />
in a hostile environment incompatible with the behavioural reaction the patient<br />
had, and with the consequent sensation of danger the diver had exposed himself<br />
to through his own behaviour.<br />
A first reconstruction revealed that the panic attack had led to an anticipatory<br />
anxiety mechanism which led the person to a progressive limitation on<br />
behaviour and habits in life. The first avoidance had involved the person’s social<br />
life, strongly connected to identity (of diver and guide). This had engendered a<br />
depressive reaction, connecting giving up work and social life with feelings of<br />
defeat, shame, incapacity and secretiveness.<br />
There was an anxiety episode with panic in remote anamnesis in a situation<br />
not connected to diving, with a subjective experience of “fear of not making<br />
it” and a cognitive organisation of a phobic nature (15) (characterised by periods<br />
of constraint a fear of physical inadequacy to effort).<br />
In recent anamnesis, in the days immediately preceding the dive, the<br />
person had had to face a very important interpersonal conflict, a choice between<br />
a constraint on activity and the risk of abandonment.<br />
Treatment lasted 15 sessions, and was carried out with individual cognitive-behavioural<br />
psychotherapy. After the assessment phase we proceeded with the<br />
identification of disturbing recollections and their desensitisation, through the<br />
EMDR protocol (16), an activity which took up about half of the sessions. In particular,<br />
three different recollections of images were desensitised, non-elaborated<br />
recollections of as many frightening moments of the event, which had been connected<br />
to the psycho-physical response of anxiety. These images were still viv-<br />
NOTES<br />
(11) Diagnostic criteria of Post-Traumatic Stress<br />
Disorder: a person has experienced or witnessed<br />
an event or events which have implied death, the<br />
risk of death, severe injury, or a threat to their<br />
physical well-being or that of others. The person’s<br />
response included intense fear, symptoms of<br />
disempowerment or horror. The traumatic event is<br />
relived persistently in one or more of the following<br />
ways: intrusive recollections, unpleasant recurring<br />
dreams of the event, action or feelings as if the<br />
event was happening again (flash backs), difficulty<br />
in getting or staying asleep, irritability, difficulty in<br />
concentration, hyper-vigilance. The duration of<br />
the disorder is over a month. The disorder causes<br />
clinically significant disturbance. The disorder may<br />
be acute, if the symptoms last for less than three<br />
months, or chronic, if they last three months or<br />
more.<br />
(12) Adaptation disorders bring about the development<br />
of emotional and behavioural symptoms in<br />
response to one or more identifiable stress factors,<br />
which manifest from the beginning of the stressful<br />
event which caused the maladaptive reaction<br />
There can be several variations in symptoms: with<br />
anxiety, depression, change in conduct or a mixed<br />
alternation of emotion and conduct.<br />
(13) American Psychiatric Association, 2001<br />
(14) Selective serotonin re-uptake inhibitor<br />
(15) Bara, 1996<br />
(16) This is a method devised by American psychologist<br />
Francine Shapiro in 1987. Originally conceived<br />
to help people with PTSD, it was first used<br />
with war veterans. Subsequently, the method was<br />
refined both conceptually and empirically, increasing<br />
its scope to the treatment of other disorders<br />
and varying its application techniques to stimuli<br />
other than visual ones, such as tactile and auditory<br />
ones. It is now used in nearly every country in<br />
the world. The use of neuroimaging techniques is<br />
shedding light on the neural correlation of psychotherapy,<br />
revealing its neurobiological effects on<br />
cerebral functions. The method is currently used<br />
in the psychotherapies, especially the behavioural<br />
and cognitive kind, through a rather rigorous eightphase<br />
protocol.<br />
# 47 (1st Quarter 2012) 33
Features<br />
<strong>Diving</strong> the<br />
uss Barometer<br />
By Richard Vann<br />
36<br />
Diver shayne Pemberton of richardson,<br />
texas, was messing around in<br />
his turtle pond. he filled a jar with<br />
water, raised the closed end above<br />
the surface of the pond, and a fish<br />
swam up into the jar. this got him<br />
thinking. What if the jar were 10 feet<br />
(3 meters) in diameter, 60 feet (18 m)<br />
long and filled with sea water? suppose<br />
the open end were under water<br />
and the closed end above sea level.<br />
What would be the pressure at sea<br />
level inside the jar? What would happen<br />
if a diver swam up into the jar?<br />
A jar of water 60 feet tall is like a mercury<br />
barometer used to measure atmospheric<br />
pressure. The actual barometer<br />
is a glass tube about a quarter of an<br />
inch (6.35mm) in diameter, filled with<br />
mercury with its open end inverted in a<br />
small pool of mercury (see Figure 1).<br />
The mercury in the upper end of the tube<br />
falls away from its sealed top by about<br />
an inch and hangs there at a height of<br />
about 30 inches (76 cm) above the surface<br />
of the mercury pool. The length of<br />
the column is equivalent to a pressure -<br />
the atmospheric or barometric pressure<br />
- 14.7 pounds per square inch absolute<br />
(psia). If a storm passes through or the<br />
barometer is carried up a mountain<br />
(that’s what the “natural philosophers”<br />
did during the 1600s), the height of the<br />
mercury column falls as the barometric<br />
pressure drops.<br />
The mercury column stands above the<br />
pool of mercury because the atmos-<br />
pheric pressure on the surface of the<br />
pool pushes it up the tube. The “empty”<br />
headspace at the top is really filled<br />
with mercury vapor.<br />
To illustrate this point, you could make<br />
a barometer with sea water instead of<br />
mercury (avoid physical contact with<br />
mercury, as it is toxic). If the closed<br />
end of a seawater-filled tube were<br />
gradually raised above sea level, it<br />
would remain completely filled with<br />
water until the height reached 33 feet<br />
(10 m). Above this height, the sea water<br />
would pull away from the end of<br />
the tube, hang at 33 feet and would<br />
rise no further, no matter how high the<br />
tube was raised. If the tube were large<br />
enough to dive in, a diver would note<br />
that the pressure decreased as he or<br />
she ascended.<br />
Figure 1:<br />
Simple mercury (Hg) barometer.<br />
# 47 (1st Quarter 2012) 37
Features<br />
In the Chamber<br />
Text and photos: Christian Skauge (www.scubapixel.com)<br />
How does a 60 meter dive on<br />
air really feel?<br />
The depth gauge says 60.2<br />
meters, and my voice sounds<br />
like Donald Duck’s. My fingers<br />
are so numb they feel like they<br />
belong to someone else and I<br />
get disoriented just by turning<br />
my head – it feels like it keeps<br />
spinning.<br />
40<br />
A trip to the local decompression chamber<br />
will teach divers a valuable lesson<br />
about the dangers of the deep.<br />
# 47 (1st Quarter 2012) 41
Features<br />
These are symptoms you are likely to get while diving, if you venture<br />
too deep or have the wrong gas in your tanks. It goes without<br />
saying that it would not be a good experience under water, not to<br />
mention downright dangerous. Luckily, we are not under water, but<br />
in the safety of the decompression chamber at the Ullevål university<br />
hospital in Oslo.<br />
Safe environment<br />
I have never dived to 60 meters, not on air or anything else – and<br />
I will not try to do so after this experience, except maybe on trimix.<br />
For those wanting to be a deep diver a trip to a decompression<br />
chamber is certainly a wake-up call. If your body functions this badly<br />
at depth in a warm, safe environment - how will you handle things<br />
when it’s cold, dark, bad visibility, current and stress? I for one do<br />
not want to find out.<br />
For those who want to feel the tug of the deep, Oslo-based dive<br />
shop Dykkersport hosts trips to the decompression chamber at the<br />
Ullevål university hospital. I was surprised when I got there – the<br />
room was full of people and it took three turns in the chamber for<br />
everyone to experience the deep and the effects of nitrogen narcosis,<br />
high pressure and air.<br />
Lifesaving treatment<br />
The decompression chamber at Ullevål is operated by the local fire<br />
department, and three of their rescue divers were present to serve<br />
as “tenders” – the person responsible inside the chamber when it is<br />
under pressure. The chamber was established in 1981, and since<br />
then around 50 treatments a year has been conducted. About half<br />
of these are different kinds of medical treatments on regular patients,<br />
and the rest are divers who have had some kind of accident<br />
– the bends or regular decompression sickness, DCS. Most of the<br />
time, divers are put in the chamber as a precaution, but sometimes<br />
it is serious and the treatment is lifesaving or at least very important<br />
to avoid serious consequences after an accident.<br />
Drunk as a Skunk<br />
Our “dive” in the chamber is luckily just exciting, and no-one has to<br />
worry about DCS. There is a loud hiss as compressed air is pumped<br />
into the chamber, and pressure on the ears is sudden and persistent.<br />
Equalizing immediately becomes a necessity! The chamber<br />
operator takes us down to three meters to make sure everyone’s<br />
42<br />
sinuses are clear and up for the dive – and then we drop to 60 meters<br />
in just 2-3 minutes. It felt just like being on a rollercoaster and<br />
seeing the top of the track getting closer… knowing that there is a<br />
drop on the other side. Exciting!<br />
On the way down you can feel the nitrogen narcosis taking effect,<br />
but it is when you hit the bottom (so to speak) the effects of air and<br />
depth really hits you: It is hard to breathe air that is seven times<br />
denser than on the surface - it feels more like a thin liquid. When<br />
you wave your hand through the air you can actually feel the density!<br />
Initially I feel pretty good, but when I turn my head to look at<br />
the guy next to me it feels as it just keeps spinning. I am dizzy, off<br />
balance and completely unable to think straight. Boy, am I glad I’m<br />
not in the water!<br />
The pressure also affects your vocal chords, and the moment you<br />
speak you sound just like Donald Duck. Laughter is quickly spreading<br />
in the chamber, resulting in even more laughter because it just<br />
sounds completely ridiculous. Still, we are trying to discuss how<br />
we’re feeling - but even quite serious narcotic symptoms like numb<br />
fingers, dizziness and complete lack of coordination is lost in a<br />
cascade of cartoon-like laughter. We are completely wasted! The<br />
party goes on, and it doesn’t take long before the classic Beatles<br />
tune “Yellow submarine” reverberates through the chamber.<br />
When it’s serious<br />
If a diver has had an accident and needs recompression, the depth<br />
is naturally shallower than 60 meters. A normal recompression<br />
treatment takes place at 18 meters depth, and can last anything<br />
from a few hours to several days of repeated treatment, depending<br />
on the situation. The atmosphere inside the chamber quickly<br />
grows moist, dense and very warm, and I can only imagine the<br />
stress a real patient must feel in addition to these nuisances.<br />
I don’t know if I would be scared to death or relieved if it was me in<br />
the chamber – maybe a little of both. I would be scared of the consequences<br />
of DCS, but relieved to be under treatment and taken<br />
care of by seasoned professionals. Anyway, it is not a situation I<br />
want to be in – or want anyone else to have to experience. I will<br />
definitely keep this in mind on future dives, especially when the<br />
devil of the deep is trying to lure me down for a visit into his kingdom.<br />
Figure 1:<br />
The decompression chamber at the<br />
Ullevål university hospital in Oslo<br />
can accommodate up to 10 people<br />
at a time, and is on a 24-hour alert.<br />
Figure 2:<br />
The maze of pipes and hoses coming<br />
from the ceiling of the chamber<br />
are for the BIBS masks used to<br />
administer pure oxygen.<br />
# 47 (1st Quarter 2012) 43
DAn research<br />
The pleasure of safety<br />
Wellness & underwater activities in the Maldives<br />
By Cristian Pellegrini<br />
Travel <strong>notes</strong> by Massimo Pieri<br />
# 47 (1st Quarter 2012)
DAn research<br />
54<br />
north Ari Atoll, maldives (4°13’n – 72°46’e), 7-14th november 2011<br />
Here we are again in this patch of land surrounded by the ocean, to continue the research we<br />
began on our last trip, just a year ago.<br />
At the first rendezvous in Gangehi, we had underlined the importance of pre- and post-dive tests, of<br />
donating diving profiles to research, and that of relaxation techniques borrowed from free diving.<br />
This time, there are some important novelties. We will accompany all the divers staying at the<br />
Gangehi Village Island Resort (Best Tours) for the whole week,<br />
suggesting an experimental programme for them: themed evenings<br />
with medical-scientific presentations, practical advice and<br />
a new protocol which applies diver preconditioning techniques for<br />
the reduction of decompression risks.<br />
We have called this pilot programme Wellness <strong>Diving</strong>. It is a way<br />
of associating entertainment with practicality, combining scientific<br />
rigour with pure pleasure.<br />
In some research camps organised by DAN Europe<br />
DSL, some tests diver pre-conditioning tests<br />
have already been carried out. These have given<br />
surprising results on post-dive bubbles.<br />
Hydration, relaxation, total body vibration, dark<br />
chocolate, saunas and infra-red light: these are<br />
some of the things we tried on divers pre-dive.<br />
Wellness applied to divers was something Prof.<br />
Alessandro Marroni spoke about back in 2008:<br />
“Even though it may seem strange and just a fad,<br />
the concept is not so far from truth: the data which<br />
is emerging shows that some pre-immersion procedures,<br />
totally non-invasive and even rather pleasant,<br />
have a significant preventive or protective effect<br />
against decompression stress and that from diving<br />
in general.<br />
Furthermore, it has become well-known and it is scientifically<br />
proved that a good “aerobic fitness” condi-<br />
tion is associated with a reduction in decompression risks.<br />
All this could very well be framed in the context of “pre-diving wellness”, and why not? Seeing<br />
as that these are simple procedures to enact and which require no particularly complex or<br />
costly equipment, one could envisage pre-dive ”wellness areas” in future diving centres and<br />
even on dedicate diving cruise vessels.”<br />
three years later, this is exactly what Dsl is proposing to the gangehi divers.<br />
What more appropriate place could there be than a small Maldives island to test the project?<br />
Organization and logistics are fundamental in these phases. Alberto Bonotti, responsible for the<br />
Albatros Top <strong>Diving</strong> centre of Gangehi, has already organised everything so that the day after<br />
our arrival all the procedures can be carried out quickly and precisely.<br />
The protocol lays out that 12 divers, divided in groups of 3, will carry out basic tests before<br />
exposure, then undergoing their assigned pre-conditionings.<br />
The 4 groups are: Vibration, Chocolate, Control Group, Guides.<br />
Our divers will be “vibrated” before the beginning of the series of dives and will have dark<br />
chocolate (75% cocoa) every day, to stimulate protective mechanisms.<br />
Total body pre-immersion vibration (see analysis) leads to a depletion of gaseous micronuclei<br />
and their significant reduction after diving, as compared to profiles without pre-vibration<br />
(preliminary reduction of gaseous nuclei to optimise decompression).<br />
Chocolate on the other hand produces NO (Nitric oxide), which acts as a vasodilator and<br />
protector of endothelial integrity (the endothelium is the tissue which lines the<br />
inside of our blood vessels). If blood vessels dilate, it is harder for<br />
bubbles to get trapped. The preventive action of NO also hinders<br />
the sticking of the bubbles to the endothelial wall.<br />
Dawn of 7 november 2011. here we are, finally on the island,<br />
welcomed by a small shark swimming in the lagoon. We are in a<br />
truly magical place, where anything can happen and any encounter<br />
can leave emotional traces.<br />
The first day of work is carried out in complete serenity. Control<br />
procedures foresee the use of a thermal camera, which will<br />
help understand interaction with the warm Maldives waters in the<br />
dives.<br />
# 47 (1st Quarter 2012) 55
56<br />
We will also use cardiac echography for the<br />
visualization of post-dive gaseous bubbles.<br />
We have decided to also include the guides’ group in<br />
the diving test, so that we may see the effects on subjects<br />
who are exposed to the hyperbaric condition for<br />
longer and who dive repetitively.<br />
The first checks generally showed a normal production<br />
of bubbles, which we expected. This stayed within<br />
security limits, varying between grades 0.5 and 1.5<br />
– known in jargon as LBG (Low Bubble Grade). Only<br />
in two cases do we find values between 2 and 3 -<br />
HBG (High Bubble Grade).<br />
Monitoring was to be carried out for the whole week and at the end of each day’s diving, so to<br />
have a daily evaluation of the bubble rate. We asked the guides to perform an extra evaluation<br />
task on their work, using a scale of 0 to 5, where zero is the greatest degree of relaxation and<br />
serenity during the dive, bearing in mind two factors: emotional (stress) and physical (underwater<br />
work load).<br />
The themed week included two evening presentations of DAN and its DSL (<strong>Diving</strong> Safety Laboratory)<br />
projects. This information was also appreciated by the non-diving guests of the village.<br />
Particular curiosity was generated by the PFO (patent foramen ovale), perhaps due to recent<br />
news which involved a famous soccer player. To know its effects on diving was even more<br />
interesting.<br />
DAN has been studying this phenomenon for several years, providing appropriate guidelines.<br />
The audience’s interest then concentrated on the tight bond between research and health, like<br />
that highlighted by studies on free-divers with changes to their haemoglobin after diving and<br />
flying.<br />
speaking of this project, we showed how heavy air is!<br />
Starting from Italy with Dr. Cialoni, we had the idea of taking a bottle<br />
of water, drinking 2/3 of the content and then leaving it subject to<br />
the pressure variations of the cabin for the whole flight. Obviously,<br />
the bottle became compressed, but not completely, as the liquid and<br />
compressible part offered some resistance. A banal example which<br />
shows how important the pressure variations during flight can be,<br />
# 47 (1st Quarter 2012)<br />
especially for a diver returning home by plane after several days of diving. DAN has thus established<br />
some simple rules: 12 hours of interval after a curved dive profile, 24 hours after repetitive<br />
dives or ones outside the curve. Another small suggestion to take on your travels.<br />
Dr. Cialoni’s presentation was another intense moment in the soirées. Danilo provided guests<br />
with a free-diving simulation and a video of Umberto Pelizzari setting the world record at 80<br />
metres. Spectators were asked to hold their breath whilst they watched the video with the best<br />
techniques they knew.<br />
But is free-diving just about holding your breath? Obviously not! It is probably the search for a<br />
sensation of well-being which, with the appropriate techniques, motivates the need to breathe<br />
to the limits, without going beyond them... Now the video is still playing, the viewers have<br />
to hold their breath a little longer and Pelizzari perhaps only feels like giving in once he has<br />
reached the surface... what a sensation! Danilo, you took us on a marvellous dive!<br />
Still on the theme of breath-holding, one of the highlights of the week is the session dedicated<br />
to relaxation and breathing techniques held on a narrow stretch of sand. Divers<br />
and others took part. It’s an almost mystical moment. We are taken to an oasis of relaxation,<br />
listening to the gurgle of the small waves breaking on the sand. The hustle and bustle of everyday<br />
life is far away: each one of us establishes a connection with our inside part and listens<br />
to him/herself breathe...<br />
Right at the end of the relaxation session, a beautiful turtle surfaces<br />
onto the sandy stretch, bringing us back to reality.<br />
***<br />
A heartfelt thanks goes to Best Tours, which helped us manage<br />
the mobile research laboratory and provided the Gangehi island<br />
venue. Thanks also to Albatros Top <strong>Diving</strong>.<br />
Analysis<br />
total body vibration for depletion of gaseous micronuclei<br />
Effect: reduction of gaseous nuclei to optimise decompression.<br />
How to do it: divers are vibrated on purpose-built beds for a set<br />
time, 30 minutes before immersion.<br />
It seems that the vibrations significantly reduce the number of bubbles<br />
found in divers after immersion. The study began after interesting reports<br />
from divers on the Côte d’Azur who noticed far less decompression<br />
problems after adopting a peculiar strategy: they would race their<br />
dinghies at full speed so as to “shake” the bubbles before diving, then<br />
returning slowly so as not to shake them afterwards.<br />
57
insurance matters<br />
Insurance<br />
Matters<br />
Probably the only specialist diving<br />
insurance company worldwide<br />
# 47 (1st Quarter 2012)<br />
<strong>Diving</strong> Insurance: A Choice or A Must?<br />
By Julian Boffa<br />
Probably the only specialist diving<br />
insurance company worldwide<br />
Why spend money to insure? “It will<br />
never happen to me.” So have said not tens, not<br />
hundreds, but thousands of people who have been<br />
assisted by DAN Europe each year. These are the<br />
same people who now appreciate the importance of<br />
being insured by a provider who cares, is reliable,<br />
and what’s more, is specifically created by professionals,<br />
with a network of experts in the field ready to<br />
assist you. Some people may choose to become insured because it is mandatory<br />
by local law, or required by their teaching organization. Though even if this is not<br />
the case for you, is insurance still a must? Are the benefits of your insurance only<br />
tangible after a claim?<br />
It goes without saying that any incident, whether great or small, implies financial<br />
consequences. On top of the emotional distress caused by a medical emergency,<br />
there is the hassle of dealing with what comes next... making sure your insurance<br />
provider is immediately there for you. Having the guarantee of financial assistance<br />
is comforting, but what is more comforting is having the reassurance that<br />
someone will be there to take care of you throughout the whole ordeal. You’ve<br />
probably heard someone say that buying insurance is like buying<br />
“peace of mind”. It’s a “just-in-case” means of support that makes you feel<br />
more secure in those unpredictable circumstances. However the fine print of buying<br />
insurance goes beyond just peace of mind and the guarantee of payment of<br />
claims. The service one chooses is made up of two components, namely pre-loss<br />
and post-loss.<br />
Pre-Loss service: Insurers are interested in minimizing the occurrence of claims,<br />
in other words, reducing the possibility that something can happen to you. They<br />
therefore have a vested interest in ensuring that the various industries involved<br />
in the sport continue to work at improving the safety standards of the activity being<br />
insured. Therefore many insurers, such as International <strong>Diving</strong> Assurance<br />
63
insurance matters<br />
Probably the only specialist diving<br />
insurance company worldwide<br />
(IDA), actually invest a part of the premium together with DAN Europe<br />
towards medical and safety research, which in turn helps to<br />
avoid a loss, or at least minimize the effects. Another part of the<br />
funds collected go towards financing educational campaigns, promoting<br />
diving safety strategies and conducting site visits to identify<br />
potential hazards, all of which give dive professionals information<br />
on how to avoid accidents. Furthermore, an insurer, or more so an<br />
insurance broker (such as DAN Europe Insurance Brokers Ltd),<br />
will assist members and clients on purchasing the right coverage,<br />
and help them access important information on the risks they may<br />
face. These types of services are an enormous benefit to the diving<br />
industry, as ultimately, working toward the prevention of accidents<br />
is better than treating them.<br />
Post-Loss service: Notwithstanding all the efforts taken to assure<br />
one’s safety, some unfortunate incidents can still occur, and this<br />
is where your insurance provider lends a helping hand. Prior to<br />
reimbursing a claim, there are many other areas in which you may<br />
require assistance: choosing the right medical facility, acquiring the<br />
correct and appropriate treatment, taking precautionary measures<br />
against exploitative foreign hospitals, organizing repatriation logistics,<br />
and obtaining legal advice. An insurer like IDA together with<br />
DAN Europe will guide you through all the necessary steps to properly<br />
handle any difficult situation. Can you imagine the distress of<br />
being in a foreign country and having to manage all these matters<br />
yourself during an emergency?! Having someone well trained and<br />
# 47 (1st Quarter 2012)<br />
experienced working alongside you is not only essential; it is priceless.<br />
“I know what I’m doing. I’ve been diving for years and nothing has<br />
ever happened to me!” A friend of mine once told me that living in<br />
trees for 30 years does not make one a monkey. Likewise, no matter<br />
how much of a professional you are or how much diving experience<br />
you have, you won’t grow gills, and therefore there will always<br />
be risk factors involved in diving.<br />
So what can go wrong? Our experience at DAN Europe has shown<br />
that the majority of diving accidents are in fact preventable, and in<br />
most cases are due to human error and misjudgment. Getting distracted<br />
or overlooking something minor can prove very costly in an<br />
environment where access to advanced medical assistance is very<br />
limited or far away. Furthermore, a large number of accidents are<br />
not caused by external factors, but by “diver panic.” Being an experienced<br />
diver is certainly helpful in handling a risky situation, but<br />
is not always a guarantee of preventing one. Once panic sets in, it<br />
is difficult or sometimes impossible to regain composure. Also, experienced<br />
divers with expert knowledge of procedures and precautions<br />
can tend to ignore certain safety standards, for example going<br />
into deco without an adequate air supply because of distraction.<br />
65
sea stories<br />
68<br />
mutual respect<br />
Do the Guadalupe White Sharks Coexist with Pinnipeds?<br />
At remote Guadalupe Island, a migration takes place. It has been studied for only a few years.<br />
Great white sharks (Carcharodon carcharias) migrate through, following large schools of<br />
tuna, one of their favorite foods. From September to December, these animals share the<br />
sea surrounding this island approximately 145 miles (232 kilometers) off Mexico’s Baja<br />
peninsula with Guadalupe fur seals (Arctocephalus townsendi), northern elephant seals<br />
(Mirounga angustirostris) and the common California sea lion (Zalophus californiacus).<br />
On trips to photograph the great white sharks, no one in my group witnessed predatory<br />
behavior toward any of these pinnipeds (literally “wing-footed,” as the shape of their flippers<br />
suggest). Paul “Doc” Anes, a pioneer in white shark diving at Guadalupe, says he has<br />
never witnessed any such predation since 2000, when these expeditions began. “We did<br />
see a white shark eat a bird, though,” Anes said.<br />
by David Haas<br />
# 47 (1st Quarter 2012)<br />
69
sea stories<br />
Turtle Islands<br />
Marine Park<br />
by Elizabeth Cook<br />
A tumble, a tussle, a tangle - of turtles. These terms describe<br />
the flight of the fledglings scrambling across the sand. There<br />
is something incredibly cute about the miniature reptiles. Like<br />
children playing in their parents’ clothing, with pants too long and<br />
shirt sleeves rolled up, the baby turtles are gangly, dressed in<br />
flippers too large for their carapaces, with heads too tiny for their<br />
bodies. Gently dumped from a bucket in the dark of the night,<br />
they sort themselves out and turn nose to the water. Their tiny<br />
flippers flail at the sand, struggling to pull their too-heavy shells<br />
toward the sea.<br />
My first question is: “Since it’s dark out, how do they know where<br />
the water is?”<br />
“They always head toward the light of the horizon,” the ranger<br />
tells me. Testing his theory, I flick my flashlight toward a few<br />
stragglers, who turn and follow the beam. The rangers gather<br />
them up in buckets and carry them down to the sea. With a little<br />
help, their journey begins.<br />
I’m visiting Turtle Islands Marine Park, off the coast of Sabah,<br />
Malaysia, and getting a lesson in turtle-rearing. The park has<br />
two purposes: one, to collect data and study the local turtle<br />
population; and two, to assist in the survival of these ancient<br />
reptiles.<br />
To this end, the Malaysian government mandated that the<br />
islands of Selingaan, Gulisan and Bakkungan Kecil, off the<br />
northeast coast of Sabah, provide a sanctuary for the animals.<br />
I’m also learning that these islands are only a subset of a chain<br />
of islands that stretch from Sabah to the southern Philippines.<br />
In 1996, in a gesture of international cooperation, Malaysia and<br />
the Philippines joined together to protect this rookery of primarily<br />
green sea turtles (Chelonia mydas) by establishing the Turtle<br />
Islands Heritage Protected Area (TIHPA).<br />
72<br />
# 47 (1st Quarter 2012)<br />
73
sea stories<br />
The egg hunt<br />
About 10 p.m., the park ranger signals me and three other<br />
guests that it’s time. He instructs us to be quiet and do nothing to<br />
disturb the nesting. Trailing behind the guide, we walk along the<br />
beach until we encounter tracks emerging from the sea: They<br />
look like they were made by a large vehicle. Following the tracks<br />
up the beach into the trees, we stop and listen. We can hear the<br />
subtle sound of a turtle’s heavy breathing. Moving close behind<br />
the guide, we see a nesting turtle flicking sand aside, forming a<br />
shallow pit.<br />
For a moment, the mother turtle rests in the sand hollow. With<br />
what seems a sense of turtle urgency, her hind flippers begin to<br />
flip cupful after cupful of sand out as she excavates a vertical<br />
chamber nearly two feet (a half-meter) deep. Satisfied with the<br />
depth and without missing a beat, she begins dropping her eggs<br />
into the nest, one at a time at first, then more rapidly, two and<br />
three at a time.<br />
The ranger reaches into the nest and pulls out what looks like a<br />
ping-pong ball; the egg is similar in size and color, with a thick<br />
parchment-like skin. Gently removing the eggs, the ranger places<br />
them in a bucket as the mother turtle continues her deposits;<br />
she seems oblivious to the theft.<br />
This female deposits 94 eggs in an hour and then rests for a<br />
couple of minutes. The ranger takes this opportunity to see<br />
that she has a numbered tag attached to her flipper and writes<br />
down the number. Resuming her work with her back flippers,<br />
Mom packs sand in the hole and, as a final touch, sweeps the<br />
nest area with her long front flippers, possibly to disguise it from<br />
predators.<br />
For another minute, we watch in silent respect and then retreat<br />
as she finishes her work. In another two weeks, she may return<br />
and lay another clutch, as these egg deposits are called, then<br />
not return for several years.<br />
Following our guide to the hatchery located some 50 feet (15 m)<br />
above the high-tide line, we watch him carefully place the eggs<br />
in a prepared nest. Each nest is roughly 30 inches (75 cm) deep<br />
and surrounded by wire mesh to keep out predators. A marker<br />
<strong>notes</strong> the date, the number of eggs and a unique identification<br />
number.<br />
The clutch will begin hatching in 45 to 60 days. Early hatchers<br />
stay hidden under the sand until their siblings are ready. Then,<br />
as if on cue - perhaps from the cooling temperature of the sand<br />
after sunset - they all emerge simultaneously from the nest one<br />
night and race for the sea.<br />
74<br />
Facts - and Mysteries<br />
The perils of being a turtle start even before it hatches. Monitor lizards unearth and eat the eggs,<br />
and ants can wreck a nest. Inadvertently, other turtles digging nests nearby disturb existing<br />
nests. Once the eggs are exposed, sea birds pick off the eggs, or the hot sun dehydrates<br />
them. And, of course, poachers can eradicate an entire nest in one visit. For all these<br />
reasons, the rangers remove the eggs and keep them in the protective safety of the hatchery.<br />
A great deal about turtles is still unknown. I ask the ranger, “What’s the ratio of males to females that<br />
are born?”<br />
Temperature seems to play a large part of whether the turtle will turn out to be a male or a female,<br />
he says. “Nests under shade-providing trees or nests dug deeper in the sand tend to produce more<br />
males,” he says. Even time of the year seems to have an effect; cooler months of the year produce<br />
significantly more males.<br />
The ranger looks up the tag number of our turtle mom. “She was first tagged here on Pulau Selingaan<br />
on Oct. 10, 2003, and 16 days later she came back and laid another 114 eggs,” he says. We wonder if<br />
she’ll come back again this year.<br />
Given the difficulty of studying turtles once they reach the open sea, lots of unanswered questions<br />
remain. Tagging started about 50 years ago with the use of metal tags. Still used today, the tags are<br />
sometimes supplemented by radio transmitters and satellites. These tools provide scientists with much<br />
more extensive data about such things as migratory patterns and how long turtles can stay submerged.<br />
With the advent of DNA sampling, researchers can prove that mothers return to the place they were<br />
born to give birth. They also tell us that turtles migrate thousands of miles. So how do the female turtles<br />
remember where they were born? A beach is a beach, after all.<br />
Scientists don’t agree on the answer, but theories include the possibility that turtles follow a certain<br />
signature smell, much like a pheromone that distinguishes one beach from another. Another theory is<br />
that they have built-in compasses and a magnetic mental map of their birthplace.<br />
“Why do we only see full-grown turtles when we’re diving?” I ask.<br />
Our guide says that scientists don’t really know much about where baby turtles go. “They’ve been<br />
tracked swimming from the beach out to sea for more than 24 hours,” he says. “But beyond that, we<br />
just don’t know.<br />
“We do know that when they get to be a little larger than a dinner plate, they start to be seen closer to<br />
land.” It is thought that turtles spend their childhood - some three to seven years - far out at sea.<br />
I’ve learned a lot tonight but have two final questions: “How old do turtles have to be before they<br />
reproduce? And what is their survival rate?” The answers to these questions are crucial to whether<br />
turtles survive as a species. Scientists’ best guess is that, depending on the species, turtles do not<br />
begin reproducing until they are at least 10 to 25 years old.<br />
This means that a turtle has to survive a long time before it can even begin to contribute to the<br />
continuation of the species. Unfortunately, the answer to the question about survival rate is even more<br />
profound. Scientists believe that only one hatchling in a 1,000 reaches reproductive age.<br />
# 47 (1st Quarter 2012)<br />
75
sea stories<br />
The future<br />
Six, some say seven, species of sea turtles populate the world’s oceans.<br />
Except for the flatback turtle, they are all listed with conservation organizations,<br />
such as the World Wildlife Fund, as critically endangered or endangered.<br />
International cooperation is important to turtles’ survival, because turtles<br />
migrate across the waters of many countries. Local cooperation is important<br />
because these are the communities and organizations that can protect nesting<br />
sites and patrol for poaching. And finally, individuals can do simple things<br />
such as clean up trash from beaches, limit their use of products that produce<br />
harmful run-off into the oceans, and reject products that are harvested from<br />
turtles. These contributions can make a difference to whether turtles, which<br />
survived the extinction of the dinosaurs 65 million years ago, will survive the<br />
lack of knowledge or indifference of people today.<br />
Marine turtles are reptiles found in every tropical destination around the world.<br />
Nearly all the world’s species can be found in North American and Caribbean<br />
waters. They are the green (Chelonia mydas), hawksbill (Eretmochelys<br />
imbricata), Kemp’s ridley (Lepidochelys kempii), leatherback (Dermochelys<br />
coriacea), loggerhead (Caretta caretta) and olive ridley (Lepidochelys<br />
olivacea). There is some scientific debate whether there is a seventh unique<br />
species. The black turtle, a.k.a., Eastern Pacific green turtle (Chelonia agassizii<br />
or Chelonia mydas agassizii) is sometimes recognized as a unique species,<br />
sometimes recognized as a subspecies of the green turtle and sometimes not<br />
recognized uniquely. Australia’s flatback turtle, first discussed in the 1880s, is<br />
still debated as to its status as a separate or a subspecies.<br />
76<br />
Facilities at Turtle Islands Marine<br />
Park<br />
Selingan Island is the only one of Malaysia’s Turtle Islands that has been<br />
opened to the public for overnight stays. It is home to the park headquarters,<br />
a modest visitor center, the turtle hatchery and most recently, several chalets<br />
for overnight guests and a small place to dine. The closest mainland town is<br />
Sandakan about an hour away by speedboat and renowned for its Orangutan<br />
Rehabilitation Centre.<br />
About the Team<br />
Elizabeth Cook is a freelance photojournalist and<br />
technical writer. When not diving and shooting<br />
underwater photos in Southeast Asia and off the<br />
coast of California, she makes her home in San Diego.<br />
Elizabeth has been a committed DAN Member for a<br />
decade.<br />
Robert Yin is a freelance photojournalist and a DAN<br />
Member from San Diego. He dives mostly in the tropical<br />
Pacific. His photos appear in many books and dive<br />
magazines. He has authored 24 books in the “Marine<br />
Life for Young Readers” series and a coffee-table book,<br />
“Beneath Philippine Seas”.<br />
# 47 (1st Quarter 2012)<br />
77
DAn<br />
mission<br />
statement<br />
DAn euroPe FounDAtion<br />
DAN Europe Balkans<br />
(Serbia and Montenegro, Bosnia<br />
and Hezegovina)<br />
DAN Europe BeNeLux<br />
(Belgium, Netherlands, Luxembourg)<br />
DAN Europe Česko<br />
DAN Europe Croatia<br />
DAN Europe France<br />
DAN Europe Germany, Austria &<br />
Hungary<br />
DAN Europe Hellas<br />
DAN Europe Ibérica<br />
(Andorra, Portugal, Spain)<br />
DAN Europe Italia<br />
DAN Europe Malta<br />
DAN Europe Polska<br />
DAN Europe Skandinavien<br />
(Denmark, Norway, Sweden, Finland)<br />
DAN Europe Slovenia<br />
DAN Europe Portugal<br />
DAN Europe Suisse<br />
DAN Europe Türkiye<br />
DAN Europe United Kingdom<br />
Gibraltar & Ireland<br />
DAN Europe (Divers Alert Network Europe) is an international non-profit medical and<br />
research organization dedicated to the safety and health of recreational scuba divers.<br />
Founded in 1983, DAN Europe exists to provide expert information and advice for<br />
the benefit of its members and the diving public.<br />
DAN provides emergency medical advice and assistance for underwater<br />
diving injuries, works to prevent injuries and to promote diving safety, supports<br />
underwater diving research and education, and strives to provide the most<br />
accurate, up-to-date and unbiased information on issues of common concern to<br />
the diving community.<br />
DAn euroPe AFFiliAte<br />
orgAniZAtions<br />
DAN Maldives<br />
DAN Egypt<br />
DAN Israel<br />
the other<br />
internAtionAl DAn<br />
orgAniZAtions<br />
DAN America<br />
DAN America - Mexico<br />
DAN Japan<br />
DAN Asia-Pacific<br />
DAN Asia Pacific - Philippines<br />
DAN Southern Africa<br />
our vision<br />
DAN Europe’s vision is to be the most recognized and trusted organization worldwide in the fields of diver safety and<br />
emergency services, health, research, and education by its members, instructors, supporters and recreational diving<br />
community at large.<br />
# 47 (1st Quarter 2012)<br />
79
DAn contacts<br />
DAN EUROPE FOUNDATION<br />
Regions of coverage include geographical<br />
Europe, the countries of the Mediterranean<br />
Basin, the countries on the shores of the<br />
Red Sea, the Middle East including the<br />
Persian Gulf, the countries on the shores of<br />
the Indian Ocean north of the Equator and<br />
West of India and Sri Lanka, as well as the<br />
related overseas territories, districts, and<br />
protectorates.<br />
Registered Address and Headquarters:<br />
26, Triq Fidel Zarb, Gharghur NXR07, Malta;<br />
tel. +356 2141 9804 - Fax +356 2141 9294<br />
Continental Europe Office:<br />
Casella Postale 77<br />
64026 Roseto degli Abruzzi, Italy<br />
tel: +39 085 8930333<br />
Fax: +39 085 8930050<br />
e-mail: mail@daneurope.org<br />
Website: www.daneurope.org<br />
DAn europe regional offices<br />
DAN Europe Balkans (Serbia and<br />
Montenegro, Bosnia and Hezegovina)<br />
Area Director: Prof. Alessandro Marroni<br />
Regional Director: Dr. Dragana Ivkovic,M.D.<br />
Milovana Marinkovica 17. 11000 Belgrade,<br />
Serbia and Montenegro<br />
tel / Fax: +381 11 247 10 40<br />
mobile: +381 63 8129 687<br />
email: balkans@daneurope.org<br />
DAN Europe BeNeLux<br />
(Belgium, Netherlands, Luxembourg)<br />
Area Director: Prof. Costantino Balestra Ph.D.<br />
Area Medical Director:<br />
Dr. Peter Germonpre M.D.<br />
National Medical Director for the Netherlands:<br />
Dr. Menno Gaastra M.D.<br />
Regional Head of Training (Dutch):<br />
Guy Thomas<br />
Regional Head of Training (French):<br />
Frédéric Venderschueren<br />
tel / Fax: refer to Continental Europe Office<br />
email: benelux@daneurope.org<br />
DAN Europe Česko<br />
Area Director: Prof. Alessandro Marroni<br />
National Director: Dr. Pavel Macura M.D.<br />
K Břízkám 4/7, Hradec Králové, PSC 500 09,<br />
Česká Republika<br />
tel: + 420 495 516 147<br />
Fax: + 420 495 264 641<br />
email: cekia@daneurope.org<br />
DAN Europe Croatia<br />
Area Director: Prof. Alessandro Marroni<br />
National Director: Dr. Darko Kovacevic M.D.<br />
Kruge 19A, 10000 Zagreb, Croatia<br />
Fax: +385 1 6151900<br />
email: croatia@daneurope.org<br />
DAN Europe France<br />
Area Director: Prof. Costantino Balestra, Ph.D.<br />
Area Medical Director:<br />
Dr. Peter Germonpre, M.D.<br />
National Medical Director:<br />
Dr. Bruno Grandjean, M.D.<br />
Service de Médecine Hyperbare,<br />
Centre Hospitalier d’Ajaccio, 27 Avenue<br />
Impératrice Eugénie, 20303 AJACCIO<br />
CEDEX.<br />
tel / Fax: refer to Continental Europe Office<br />
email: france@daneurope.org<br />
DAN Europe Germany, Austria & Hungary<br />
Area Director: Dr. Ulrich van Laak M.D.<br />
Eichkoppelweg 70, 24119 Kronshagen,<br />
Germany<br />
tel: +49 431 549 861<br />
(Monday, Thursday, 18-21h C.E.T.)<br />
Fax: +49 431 544 288,<br />
email: germany@daneurope.org<br />
(Hungary)<br />
national infoline: +36 30 8114451,<br />
national emergencies: +36 30 5222497<br />
DAN Europe Hellas<br />
Area Director: Prof Alessandro Marroni<br />
Medical Director: Dr Bassilis Zachariades<br />
C/o Hyperbaric Medical Center:,<br />
5 Klazomenon st., Tavros Athens, 17778<br />
tel / Fax: +30 210 3462898<br />
(Monday to Friday,14-19h)<br />
email: Hellas@daneurope.org<br />
DAN Europe Ibérica (Andorra, Portugal,<br />
Spain)<br />
Area Director: Dr. Jordi Desola, M.D., Ph.D.<br />
CRIS Unitat de Terapèutica Hiperbàrica,<br />
Dos de Maig 301, Hospital Creu Roja,<br />
08025 Barcelona, Spain<br />
tel: +34 93 347 7366<br />
Fax: +34 93 450 3736<br />
email: iberica@daneurope.org<br />
DAN Europe Italy<br />
National Director: Dr. Nuccia De Angelis<br />
Medical Director: Prof. Alessandro Marroni M.D.<br />
P.O. Box DAN, 64026 Roseto, Italy<br />
tel: +39 085 893 0333,<br />
Fax: +39 085 893 0050.<br />
email: italy@daneurope.org<br />
DAN Europe Malta<br />
National Director: Dr. Ramiro Cali Corleo M.D.<br />
26, Triq Fidiel Zarb, Gharghur NXR07, Malta.<br />
tel: +356 2141 9804<br />
Fax: +356 2141 9294<br />
email: malta@daneurope.org<br />
DAN Europe Polska<br />
Area Director: Prof. Alessandro Marroni<br />
Medical Director: Zdzislaw Sicko, M.D., Ph.D.<br />
Membership Assistance Coordinator: Jacek<br />
Kot, M.D., Ph.D.<br />
National Center for Hyperbaric Medicine,<br />
Institute of Maritime and Tropical Medicine,<br />
Medical University of Gdansk<br />
Powstania Styczniowego 9B<br />
Gdynia 81-519, Poland<br />
tel: +48 58 699 8610 (8-15h)<br />
Fax: +48 58 622 2789<br />
email: polska@daneurope.org<br />
DAN Europe Skandinavien (Denmark,<br />
Norway, Sweden, Finland)<br />
Area Director: Dr. Ole Hyldegaard, MD, Ph.D.<br />
P.O. Box 11, 2830 Virum, Denmark.<br />
tel: +45 45 836330<br />
Fax: +45 45 836 331<br />
email: skandinavien@daneurope.org<br />
DAN Europe Slovenia<br />
Area Director: Prof Alessandro Marroni<br />
National Director: Prof. Dr. Igor Mekjavic<br />
Department of Automation,<br />
Biocybernetics and Robotics<br />
Jozef Stefan Institute<br />
Jamova 39, SI-1000 Ljubljana, Slovenia<br />
tel: +386 41 696 558<br />
Fax: +386 1 423 2209<br />
email: slovenia@daneurope.org<br />
DAN Europe Portugal<br />
National Director: Dr. Oscar Ferraz Camacho<br />
Apartado 3046, 4451-801<br />
Leça da Palmeira, Portugal<br />
infoline: +351 910 49 2121<br />
(Monday to Friday, 15:30-17:30)<br />
email: portugal@daneurope.org<br />
DAN Europe Suisse<br />
National Director: Dr.Jürg Wendling M.D.<br />
Faubourg du Lac 67, 2502 Biel, Switzerland<br />
tel: +41 32 322 3823<br />
Fax: +41 32 322 3839.<br />
email: suisse@daneurope.org<br />
DAN Europe Türkiye<br />
Area and Medical Director:<br />
Dr. Ramiro Cali Corleo<br />
National Medical Director: Dr Salih Aydin,<br />
Regional Managers: Murat Egi, Ali Konoklu<br />
C/o Yavuztürk Sok, No32, D:1;<br />
Söğütlüçeşme - 34716, Kadıköy, Istanbul<br />
tel: +90 533 341 5404<br />
+90 533 448 0458<br />
email: turkey@daneurope.org<br />
Changed your address? If you have moved in the last year, please send DAN your new address.<br />
Questions? Call DAN Europe at +39 085 893 0333, or contact any of your regional offices indicated above<br />
DAN Europe United Kingdom Gibraltar<br />
& Ireland<br />
Area Director: Dr. Ramiro Cali Corleo, M.D.<br />
Regional Manager:<br />
Christopher Young, CertEd<br />
EMP House, Telford Way<br />
Coalville, Leicestershire, LE67 3HE<br />
United Kingdom<br />
tel (national): 0845 029 1990;<br />
(international): +44 845 029 1990<br />
Fax (national): 0845 029 1991<br />
(international): +44 845 029 1991<br />
email: uk@daneurope.org<br />
DAn europe Affiliate organizations<br />
DAN Maldives<br />
Area Director: Prof. Alessandro Marroni<br />
Medical Director: Dr. Guenter Frey, M.D.<br />
Bandos Hyperbaric & Medical Clinic -<br />
Bandos Island Resort, Republic of Maldives<br />
Fax: +960 44 0060<br />
email: maldives@daneurope.org<br />
DAN Egypt<br />
Area Director: Prof. Alessandro Marroni<br />
Regional Director: Dr. Adel Taher, M.D.<br />
Hyperbaric Medical Center<br />
Sharm el-Sheikh, Egypt<br />
tel: +20 69 3 660 922 or 23<br />
(10:30-18h, daily)<br />
Fax: +20 69 3 661 011<br />
email: egypt@daneurope.org<br />
DAN Israel<br />
Area Director: Prof. Alessandro Marroni<br />
Regional Director: Mr. Shai Roth<br />
P.O. Box 36667, Tel Aviv, 61366, Israel<br />
Fax:+972 3 9213838<br />
email: israel@daneurope.org<br />
the other iDAn organizations<br />
DAN America<br />
territory: United States and Canada, with<br />
regional IDAN responsibility for Central and<br />
South America, the Caribbean, Polynesia,<br />
Micronesia and Melanesia (except Fiji), and<br />
any other area not designated for the other<br />
DAN entities<br />
President and CEO: Dan Orr<br />
The Peter B. Bennett Center, 6 West Colony<br />
Place, Durham, NC 27705, USA,<br />
tel: +1 919 684 2948,<br />
Fax: +1 919 490 6630<br />
email: dan@diversalertnetwork.org<br />
Website: www.diversalertnetwork.org<br />
DAN America - Mexico<br />
Director: Dr. Cuauhtemoc Sanchez, M.D.<br />
Indiana 260-907, Col. Nápoles Mexico, D.F.<br />
03710<br />
tel: +52 55 5568 8082,<br />
Fax: +52 55 5568 8083<br />
email: danmex@hotmail.com<br />
Website: www.diversalertnetwork.org<br />
DAN Japan<br />
territory: Japanese mainland and islands,<br />
with regional IDAN responsibility for the<br />
Northeast Asia-Pacific<br />
Director: Prof. Yoshihiro Mano, M.D.<br />
DAN Japan/ Japan Marine Recreation<br />
Association - Kowa-Ota-Machi Bldg, 2F, 47<br />
Ota-machi 4-Chome Nakaku, Yokohama City,<br />
Kagawa 231-0011, Japan<br />
tel: (81) 45 228 3066<br />
Fax: (81) 45 228 3063<br />
email: dan@danjapan.gr.jp<br />
Website: www.danjapan.gr.jp<br />
DAN Asia Pacific<br />
territory: Australia and New Zealand, with<br />
regional IDAN responsibility for Papua New<br />
Guinea, Fiji, Indonesia, Malaysia, Vietnam,<br />
Singapore, Cambodia, Myanmar, Philippines,<br />
Vanuatu, Solomon Islands, Brunei, Thailand,<br />
Hong Kong, Korea, China and Taiwan<br />
Director: Mr. John Lippmann<br />
49A Karnak Rd, Ashburton, Victoria 3163,<br />
Australia<br />
Postal address: PO Box 384 Ashburton, Vic.<br />
3147, Australia.<br />
tel: +61 3 9886 9166<br />
Fax: +61 3 9886 9155<br />
email: info@danasiapacific.org<br />
Website: www.danasiapacific.org<br />
DAN Asia Pacific - Philippines<br />
Medical Director:<br />
Dr. Benjamin G. Luna, Jr., M.D.<br />
Makati Medical Center, 2 Amorsolo St.,<br />
Makati City 1200, Philippines<br />
tel / Fax: +63 2 817 5601 (office hours)<br />
or tel: +63 2 815 9911 ext. 2123 (office hours)<br />
email: blunamd@cnl.net<br />
DAN Southern Africa<br />
territory: Austral Africa, Comoros,<br />
Madagascar, Seychelles Islands, plus Kenya<br />
and Zanzibar (for residents only, European<br />
expatriates refer to DAN Europe)<br />
Director: Dr. Frans J. Cronje, M.D.<br />
DAN-SA Building, Rosen Office Park, Cnr<br />
Invicta and Third Roads, Halfway House,<br />
South Africa 1685<br />
tel: + 27 11 312 0512<br />
Fax: + 27 11 312 0054<br />
email: mail@dansa.org<br />
Website: www.dansa.org<br />
DAN Europe Email Contacts<br />
General: mail@daneurope.org,<br />
Membership: members@daneurope.org<br />
Medical: medical@daneurope.org<br />
Training training@daneurope.org<br />
DAN Europe Partner Program:<br />
partner@daneurope.org<br />
Insurance Claims: claims@daneurope.org<br />
# 47 (1st Quarter 2012)<br />
81
goodbye<br />
Photocontest,<br />
Welcome<br />
PortFolio!<br />
Photo by Iyad Suleyman<br />
the first entry<br />
for our<br />
new Portfolio<br />
section has<br />
been selected!<br />
The DAN Europe Photocontest as we know it has come to an end.<br />
Our Editorial Board is currently working on a renewed version: in<br />
the meantime, all underwater pictures received will be published in<br />
this Portfolio section. You can mail your photos to:<br />
portfolio@alertdiver.eu<br />
Our kudos to the last winner of DAN Europe Photocontest Andrey nekrasov, who won two editions<br />
(2008-2009 and 2011-12). Independent photographer and journalist, Andrey writes about diving and his<br />
travels, cooperating with different world journals.<br />
Born in 1971 in Bezhetsk, Tver area (Russia), he moved to Odessa (Ukraine), on the Black Sea coast.<br />
In 1985 he started his apprenticeship in underwater photography; the following year, he received his<br />
professional diving training at V.S.A.A.A.F. (Volunteer Society of Assistance to Air forces, Army and<br />
Fleet) in Odessa. In 1989, he became Instructor of underwater sports.<br />
Until 2008, Andrey used a Canon EOS-100 camera with housing which he himself custom-made. From<br />
then on, he started shooting with the help of a digital camera Nikon D300 with SEA&SEA camera<br />
housing. Lens: Nikon 10.5mm fisheye, Nikon 12-24mm, Nikon 60mm MACRO, Tokina 10-17mm fisheye<br />
and Flash: Subtronic Mega Color and Inon-Z240 are used for his underwater photography. He uses a<br />
Nikon 24-85mm and a Nikon 70-300mm to pursue land photography.<br />
Readers of Alert Diver and active DAN members can enjoy Andrey’s latest picture, used as cover of our<br />
Magazine – Winter Issue 4_11 and of the official DAN Members’ card for the year 2013.
DAN Partner Program<br />
The DAN PARTNERS are individuals or organizations that<br />
cooperate with us to promote DAN’s image among divers.<br />
As a DAN PARTNER you can get points or commissions, with<br />
great benefits.<br />
Learn more and<br />
sign up today!<br />
# 47 (1st Quarter 2012)<br />
Zamkowa 2A / 5 - 30-301 Krakow - Poland<br />
85
P.O. Box 164 - 3340 AD Hendrik Ido Ambacht -<br />
Netherlands<br />
Via Facheris N. 50 - 24064 Grumello del Monte<br />
- Italy<br />
# 47 (1st Quarter 2012)<br />
87
# 47 (1st Quarter 2012) 89
Shop<br />
Visit the online catalogue today and discover the complete range<br />
of DAN products!<br />
€ 21,53<br />
+ vAt<br />
€ 49,00<br />
+ vAt<br />
€ 6,40<br />
+ vAt<br />
“ossidabili” explorer<br />
This “ Explorer “ necklace is made of Bronze (leadfree) while its coloration is<br />
obtained during a galvanic process with gold and Ruthenium.<br />
The polishing of this necklace was carried out with Nickel free materials.<br />
leD light stick with DAn logo<br />
Single LED light Stick for low visibility or night dives<br />
(waterproof until 300 meters), shock proof and available in 2<br />
colours. The batteries last for about 36 hours.<br />
orange Waterproof case (type hPrc 2300)<br />
High quality orange HPRC case with DAN logo and heavy duty latches<br />
offers an excellent protection for your valuable materials. Comes with plug<br />
foam insert.<br />
The case, made of a special compound of plastic resin (TTX01 ®), has a<br />
foldable carry handle and automatic pressure adjustment valve.<br />
# 47 (1st Quarter 2012)<br />
91
Visit the online catalogue today and discover the complete range of DAN products!<br />
€ 183,13<br />
+ vAt<br />
€ 3,30<br />
+ vAt<br />
€ 16,49<br />
+ vAt<br />
DAn europe Product selection<br />
Prestan Adult cPr-AeD training manikin with cPr monitor<br />
Realistic to the eye and the touch, the Prestan Professional Adult Manikin is<br />
unlike any other on the market. Prestan’s revolutionary CPR Rate Monitor<br />
allows for instant feedback to both instructor and student regarding the<br />
rate of chest compression. This allows each student to gauge their rate<br />
of compressions on their own as well as allowing the instructor to monitor<br />
several students quickly and easily. In addition, the manikin incorporates a<br />
mechanism (“depth” clicker) to help them use the correct force to compress<br />
the chest to the correct depth.<br />
DAn keycord<br />
bc rescue Knife<br />
Whether you are a diver or a sailor, the BC Rescue knife is<br />
a prefect knife to be used in emergencies.<br />
Red and white DAN keycord with anti choking release,<br />
mobile phone connector and detachable carabiner hook.<br />
€ 8,25<br />
+ vAt<br />
€ 670,79<br />
+ vAt<br />
€ 3,39<br />
+ vAt<br />
DAn europe beanie<br />
100% Cotton, double sided “beanie” hat made exlusively for<br />
DAN Europe.<br />
You can decide what side/color to wear whenever you want!<br />
DAn cloth patch: octoPus<br />
standard “Pin index” DAn oxygen<br />
unit (with empty cylinder)<br />
This standard DAN Oxygen unit is specially<br />
developed to treat injured divers and<br />
includes a 2,5 liter Pin Index Oxygen<br />
cylinder.<br />
# 47 (1st Quarter 2012)<br />
93
organo ufficiale del Divers Alert<br />
network europe<br />
Periodico trimestrale - Anno 2012 - n.1<br />
sped. in abb.post. art.2 comma 20/c<br />
legge 662/96 - Filiale di teramo
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