SAFETY
The Critical Role of Dive Leaders in Injury Recognition by Dan Orr , President, Dan Orr Consulting
W HY EARLY REPORTING saves lives and re- duces the likelihood of a lasting injury: In the recreational diving world, incidents rarely begin as emergencies, they begin as subtle or vague symptoms. A slight tingling in the hand. Unusual fatigue. Mild joint dis- comfort. A persistent cough after surfacing. Too often, these early warning signs go unreported, dismissed as insignificant or unrelated. For dive leaders and operators, this moment, when a diver decides whether or not to speak up, is where safety is either preserved or compromised. Promoting early reporting of symptoms associated with diving-related injuries, including decompression sickness (DCS), arterial gas embolism (AGE), collectively referred to as Decompression Illness (DCI) and immersion pulmonary edema (IPE), is one of the most powerful and underutilized tools in risk management. Despite decades of diver education and improved access to diving medicine and safety resources, delay in reporting post-dive symptoms remains a persistent and potentially
consequential issue in recreational and professional diving. Early recognition and treatment of conditions such as DCI and IPE are critically important in increasing the likelihood of a positive treatment outcome. However, many divers postpone reporting their post-dive symptoms or seeking evaluation, often until symptoms worsen or become dis- abling. Delay is one of the most preventable causes of potentially lasting injury in diving. Every hour matters. What could have resolved completely may become a lifelong injury if symptoms are ignored. While some studies report no significant difference in final outcome with delays, others suggest a decreased success rate, especially for severe cases treated more than 24 hours late. When I worked at Divers Alert Network (DAN), the DAN medical staff would frequently discuss the fact that divers don’t call the DAN Diving Emergency Hotline (919- 684-9111) when they have symptoms of a diving-related injury. They call when those symptoms won’t go away. Or- ganizations such as DAN consistently emphasize that even mild or vague symptoms should prompt the diver to seek consultation. Understanding why divers delay reporting symptoms is essential for improving both training effectiveness and incident outcomes. One of the most significant contributors to delayed reporting is the vague or nonspecific nature of early symptoms of some diving-related injuries. Symptoms such as fatigue, musculoskeletal discomfort, paresthesia, mild dizziness or a persistent post-dive cough are easily attributed to benign causes including exertion, thermal stress, dehydration, or even seasickness. Because of the very nature of decompression sickness, symptom onset may be delayed for several hours, further obscuring the association with a preceding dive. This time lag often leads divers to underestimate the potential seriousness of their condition. Even symptoms of immersion pulmonary edema are frequently vague, subtle or delayed and may be mistaken for other issues such as cold stress or exertion. Divers frequently engage in downplaying the importance of symptoms. This may include rationalization (“I’ve felt
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