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- Herausgeber: Books on Demand
- Kategorie: Fachliteratur
- Serie: Les publications de l'Intitut National de Plongée Professionnelle
- Sprache: Englisch
The role of the Diver Medic Technician (DMT) is to provide care in the event of a diving accident. As this care can have a significant impact on the injured diver's life, it is crucial for the DMT to receive comprehensive training to ensure preparedness for a range of scenarios. The Institut National de Plongée Professionnelle (INPP) in Marseille, France offers IMCA DMT training in accordance with the guidelines outlined in this handbook. All concepts within this book conform to the IMCA DMT training programme and are presented in a format suitable for use during diving missions. The chapters encompass DMT principles and incorporate a "How To" section detailing optimal practices for first aid and advanced care giving, with all pertinent concepts and laws included. Additionally, the contents page provides an overview of all the chapters, and each significant subject area has its own contents page to aid comprehension and efficient information retrieval.
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Seitenzahl: 141
Veröffentlichungsjahr: 2023
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Foreword
WARNING!
This manual is not a medical textbook. It has been designed to support the INPP DMT courses and to help trainees maintain the skills acquired during the training in their daily working environment.
It is through the completion of the INPP DMT courses that you will fully understand all the concepts of anatomy, physiology, pathology and therapeutics that are summarised in this manual.
This book corresponds to the IMCA DMT training programme.
Author:
Frédéric PERREL, nurse and doctoral candidate in neuroscience at the University of Aix-Marseille.
With warm thanks to:
Proofreader:
Béatrice BUCKLEY Training Department Assistant
Head of supervision:
Eric ALBIER INPP Director Marc Borgnetta Hyperbaric Doctor
Table of Contents
INTRODUCTION
Role and responsibilities of a diver medic
Safety
Principles and priorities of first aid
Care preparation, planification and execution
Daily tasks
Emergency care
Non-emergency care
Assessment
Monitoring
DocumentaCon and reporCng
Liaison responsibiliCes
Perpetual training and preparaCon
Decision tree
ANATOMY
General information
1. Skeleton
2. The 3 types of muscles tissues (voluntary, unvoluntary, cardiac)
3. Nervous system
4. Circulatory system
5. Respiratory system
6. Blood tissue
7. Skin
8. Digestive system
9. Nephrological system
10. Endocrine system
11. Lymphatic system
DECISIONAL TREE
Tool Description
Body reaction to unusual situation – Shock status
Shock status
Global situation assessment
Diseases
Marine injuries
Thermoregulation
Physical trauma
Burns
Skin injuries
Muscle injuries
Head injuries
Thorax injuries
Trachea
Thoracic cage
Abdomen injuries
Stomach
Liver/Gall bladder
Small intestine
Large intesCne
Urinal bladder
Spleen
Joints injuries
DislocaCon
Strain
Bones injuries
Crush injuries
AmputaCon
Gas toxicity (Dalton’s law)
Oxygen
Nitrogen
Helium
Barotrauma (Bole’s law)
Descent (squeeze)
Ascent (reverse squeeze)
Management of barotrauma:
Decompression illness (Henry’s law)
Type I
Type II
HOW TO
Check and manage danger (look, listen, smell, feel)
Check casualty consciousness
Check Pulse and breathing
Airways management
Injured diver examination
Resuscitation technics
Bleeding management
Body fluids management (IV/IO)
Medical prescriptions appliance
Body temperature management
Skin injuries management
Articulation injuries management
Bones injuries management
Moving and lifting a casualty
Assessment and reporting
RESOURCES
INTRODUCTION
This part will detail:
Role and responsibilities of a diver medic
Safety
Care preparation, planification and execution
ROLE AND RESPONSIBILITIES OF A DIVER MEDIC
The DMT must always be in a state of readiness to respond to emergencies, which includes being fit and holding an up-to-date HSE diving medical to enter a hyperbaric chamber.
At the scene of an emergency, the DMT's primary concern is the 'patient' and every aspect of the activities undertaken must ensure appropriate care, safety and comfort.
The main duties of the DMT are:
Be prepared to respond - equipment checked and ready.
Respond swiftly but safely to the scene.
Control scene activities to make the environment is safe.
Gain access to patients – using special equipment where necessary.
Assess patient and situation to give immediate treatment.
Disentangle and extricate appropriately without causing further injury.
Use handling devices to transfer to safe suitable environment.
Transport to appropriate medical facilities.
Complete reports
Check equipment in preparation for further emergencies.
Personal Skills the DMT should cultivate:
Be Pleasant, establish rapport in order to inspire confidence.
Co-operative with other care providers and medical personnel.
Resourceful – ability to adapt to variable circumstances.
Self-motivated – able to use own initiative without being led.
Confident and emotionally stable – calm.
Proud of one’s personal appearance – neat and clean.
Good moral character – truthful and considerate of others – promoting trust.
Good personal habits – avoid smoking whilst providing care.
Conversational skills – avoid bad language – communicate effectively.
A good listener – listens to others – particularly the patient – report accurately.
Use these traits to promote at all times a CALM PROFESSIONAL MANNER!
SAFETY
“One ounce of prevent ion is worth a pound of cure”
Principles and priorities of first aid
First aid consists of a continuous assessment/action/reassessment loop to restore and/or maintain the vital functions of an injured person while awaiting medical treatment/evacuation.
The very first priority is the DMT himself, who must first assess the safety of the environment in order NOT to be the next victim.
Nursing priorities follow the worst-to-best rule, which is to restore/maintain vital functions first.
Only then do the DMT investigations come in to assess the probable causes and the visible effects on the victim's body.
When approaching the victim, the DMT asks simple questions to assess the victim's consciousness. When accessing the casualty, the DMT must continue the mental status assessment by giving simple commands to the casualty (open your eyes, grab my hand).
As the most important vital functions, breathing and circulation must be the first to be assessed, restored/maintained.
At this stage, the DMT must seek medical advice and/or intervention.
Once vital functions have been stabilised, the DMT must carry out a full body examination, looking for less obvious injuries such as bleeding, swelling and deformity.
First aid measures to stop/control bleeding, cool burns, maintain/restore body temperature, clean/protect wounds/injuries are applied in relation to the accident/incident history and body assessment.
Monitoring of vital signs and pain is part of the care and must be repeated regularly until medical staff take over.
The sequence of first aid is as follows:
Emergency response:
Check for environment danger (make the scene safe or move the casualty)
Check victim’s mental status with simple questions Manage airways
Check for pulse and breathing Restore/stabilize pulse and breathing
Once vital functions are stabilized:
Perform full body assessment to look for less obvious injuriesMonitor/Restore/stabilize body temperatureBurns management (cooling down burned area)Soft tissues injuries management (cleaning/disinfection/dressing)Vital signs and pain monitoringSituation response:
Analyse (when – where – what – why – who)
Request medical advice
Treatment decision tree:
Body’s injuries treatment (bleeding, dressing, suture…)
Body’s biological response treatment (hydration, urinal catheter, protection…)
DCI treatment (hyperbaric chamber)
Barotrauma treatment (medical doctor management)
CARE PREPARATION, PLANIFICATION AND EXECUTION
Daily tasks
As a member of the diving community, it is imperative that the Diver Medic Technician adheres to safe practices and advocates for safety in their professional environment with a positive and tactful approach.
Emergency care
The Diver Medic Technician is the initial healthcare provider at the site of the incident. Their primary objective should be to protect themselves prior to stabilizing any injured colleagues until medical relief and/or evacuation arrives.
Non - emergency care
This role is supervised by a Diver Medic Officer who prescribes the necessary care for casualties. This is managed by the Diver Medic Technician who typically operates the hyperbaric chamber before evacuation.
Assessment
An accurate assessment must be carried out prior to the administration of any care, to evaluate the incident or accident situation, symptoms, and physiological impacts.
An accurate assessment must be carried out prior to the administration of any care, to evaluate the incident or accident situation, symptoms, and physiological impacts. This assessment must take priority over any other actions. Misjudging the situation could result in providing the wrong care, causing further harm to the casualty.
Once the situation has been assessed, the DMT must evaluate diving history, perform a full body assessment, check vital signs, and review medical history.
Monitoring
Vital signs should be closely monitored during DMT intervention to adjust care levels. Other signs and symptoms should be monitored based on the initial assessment, including neurological and bleeding symptoms.
Documentation and reporting
Situation assessment
Monitoring
Cares provided
Medical history
Must be done at the Diver Medic Officer and other medical staff to allow care continuity during and after casualty evacuation.
Liaison responsibilities
DMT needs to maintain knowledge of which evacuation route and facilities will be utilized based on the victim's status.
Perpetual training and preparation
Being a DMT entails being prepared at any time.
To achieve this, firstly, it is important to train oneself as much as possible, including mentally preparing for DMT responses when observing everyday working situations.
Secondly, it is crucial to ensure that all equipment is operational and that one knows how to use it.
Decision tree
This book presents a decision tree to assist the diver-medical technician in determining, prioritising, and adjusting patient care.
The main stem of the diving decision tree is based on the symptoms or appearance of accidents. Priorities of care are altered depending on whether the situation arises during descent, ascent, surfacing, within 24 hours of the dive or later, and whether physical trauma happened during or after the dive. The decision tree branches from observations and symptoms of the patient. By using it as a DMT reflex, it becomes a virtual tool for daily situation assessments.
The miniaturised version depicted below is explored in detail within this book.
ANATOMY
This part is fully dedicated to human body anatomy.
To simplify study body is divided in great systems:
General information
1. Skeleton
2. The 3 types of muscles tissues (voluntary, unvoluntary, cardiac)
3. Nervous system
4. Circulatory system
5. Respiratory system
6. Blood tissue
7. Skin
8. Digestive system
9. Nephrological system
10. Endocrine system
11. Lymphatic system
GENERAL INFORMATION
Figure 1 Directional references
Figure 2 Body plane
Figure 3 Thoracic landmarking
Figure 4 Emergency body position
Figure 5 Recovery position
MEDICAL TERMINOLOGY
Prefix
Meaning
Example
Bi
Both, both sides
bi
lateral
Epi
Upon
epi
gastric
Hyper
Above, excessive
hyper
tonic
Hypo
Under, below
hypo
thermic
Inter
Between
inter
costal
Post
After, behind
post
natal
Pre
Before, in front
pre
operative
Centesis
Surgical puncture
Pericardio
centesis
Ectomy
Excision
append
ectomy
Itis
Inflammation
periton
itis
Meter
Measurement instrument
thermo
meter
Ostomy
Surgical opening
colos
tomy
Paresis
Partial paralysis
hemi
paresis
Scopy
Video body examination
Broncho
scopy
Root
Meaning
Example
Cardi
Heart
Cardi
ogram
Cerebro
Brain
Cerebro
spinal
Gastr
Stomach
Gastr
oscopy
Oste
Bone
Osteoclast
Phleb
Vein
Phleb
otomy
Thorac
Chest
Thor
acic
Abbreviation
Definition
AMI
Acute myocardial infarction
CCU
Coronary care unit
CHF
Congestive heart failure
COPD
Chronic obstructive pulmonary disease
CVA
Cerebrovascular accident
ECG
Electrocardiogram
IV
Intravenous
Table 1 Medical terminology
Figure 6 Front body
Figure 7 Back body
1. SKELETON
The skeletal system is made up of 206 bones.
The bone matrix is a composite structure that provides both compressive strength due to the mineral phase, essentially composed of calcium carbonate, and tensile strength due to the collagen network.
Calcium carbonate is a strong material but easily fractured. Collagen is a soft tissue with high tensile strength. Networking calcium carbonite with collagen gives bones many of the general properties of two-phase materials such as glass fibre and bamboo.
To achieve the tall form of the human body, the matrix differs from foot to skull in different bone shapes and sizes.
There are four main bone shapes:
Long bones: are longer than wide, characterised by a long shaft called the diaphysis. They are mostly made up of strong, compact bone structure. Long bones form the core matrix of the limbs. Extremities, called epiphyses, contain more collagen network structure, giving a spongy structure to the bone tissue.
Short bones: are as long as they are wide. They have only a thin layer of compact bone structure. Short bones are usually found in the extremities of the limb.
Flat bones: are thin and generally curved, with two parallel layers of compact bone structure sandwiching a layer of spongy bone structure.
Irregular bones: are those of irregular shape and size, consisting of a thin layer of spongy marrow surrounded by thin layers of compact bone tissue. As the name suggests, their shapes are irregular and complicated. The bones of the spine, pelvis and lower jaw are irregular bones.
The spongy part of the bone houses the bone marrow, the place where blood cells are born and mature.
The extremities of the humerus, femur and tibia, as well as the sternum, are known to contain bone marrow in a large area that is convenient for intraosseous catheterisation during first aid.
Figure 8 Human skeleton
Skull and sinuses
The human skull consists in 22 ossified joint bony structure which protects brain and four sensory organs (eyes, nose, ears, taste).
Mandibula is the only mobile part of the skull.
Figure 9 Human skull
Paranasal sinuses assure three functions:
Enlightenment of skull
Participation of temperature and humidity increasing of air intakes
Participation in dust and germs retention
Figure 10 Sinuses
Vertebral column and spinal nerves
The spine is made up of 33 vertebrae. The cervical vertebrae connect the head and trunk, the thoracic vertebrae support the rib cage, the lumbar vertebrae give structure to the abdomen, the sacrum supports the pelvic bones and the coccyx is considered to be the original human tail bone.
Vertebral column is an internal canal that protects the spinal cord from injury. The spinal cord is described in detail in the Nervous System section.
Figure 11 Vertebral column and spinal cord
An intervertebral disc lies between adjacent vertebrae in the vertebral column. They play shocks absorbers to protect the spinal cord which conduct nervous signals from brain to organs and reverse. There are 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal nerve.
Figure 12 Vertebral column and vertebrae
Rib cage
Is made with 12 pairs of ribs attached to the 12 thoracic vertebrae this cage envelope the two lungs (cf. breathing anatomy).
Figure 13 Thoracic cage
Pelvis
Figure 14 Pelvis
Upper extremity
Figure 15 Upper Limb
Figure 16 Right hand
Lower extremity
Figure 17 Lower Limb
Figure 18 Left foot
Joints
Joints are sealed-capsules liking two bones together. Synovial fluid fulfils this sealed-capsule allowing bones to move one from the other without friction. Joints are made of ligaments.
Joints, bones, muscles, nerves and ligaments together are named articulation.
Figure 19 Joint
2. THE 3 TYPES OF MUSCLES TISSUES (VOLUNTARY, UNVOLUNTARY, CARDIAC)
Muscle tissue is like an engine in a car - it enables the body to move and function. Without muscles, it would be impossible to lift heavy objects or even smile.
Muscle Composition:
Muscle Cells (Muscle Fibres): Muscles comprise minuscule cells called muscle fibres. These elongated, slender structures carry out essential functions.
Specific proteins, namely actin and myosin, play vital roles within muscle fibres. These proteins operate as workers, causing muscles to contract and relax, thus allowing for movement.
Muscle tissue contracts upon receiving electrical stimuli sent from the brain through the nervous system and relaxes when the stimuli cease.
There are three primary categories of muscle tissue within the body:
Skeletal Muscles (voluntary);
Smooth Muscles; (unvoluntary)
Cardiac Muscles.
They will be outlined in the subsequent chapters.
How Muscles Work
Contraction and Relaxation: When the body initiates movement, signals from the brain prompt muscle fibres into action. Actin and myosin proteins within muscle fibres slide together, causing muscle contraction (shortening). When these proteins separate, the muscle relaxes (lengthens).
Strength and Endurance: Different muscles possess varying attributes. Some muscles, such as those in the legs, excel in strength for activities such as running and jumping. Others, like the cardiac muscles, demonstrate remarkable endurance, constantly contracting to sustain circulation.
Skeletal Muscles, also known as 'voluntary muscles,' are connected to bones by tendons and play a crucial role in skeletal movements. Walking, lifting, or maintaining an upright posture all require the use of skeletal muscles. They account for a significant proportion of human body mass, typically around 30 to 40%. Importantly, they are under conscious control, allowing individuals to determine how and when they engage.
Tendons attach skeletal muscles to bones. When skeletal muscles contract, they apply force on the attached tendons, leading to bone movement. This interdependent relationship between muscles and bones allows for precise and coordinated movements.
Skeletal muscle fibres display a unique appearance marked by regular patterns of fine red and white lines. The striped or striated appearance is a defining characteristic that makes them identifiable. As a result, they are commonly known as striated muscles.
