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Cardiac Pulmonary Resuscitation (CPR)

Medical emergencies don't occur every day. But when they do, you should have the information and resources you need to deal with these situations. Hoofer SCUBA strongly recommends that all divers obtain the training to administer basic first aid, and cardiopulmonary resuscitation (CPR). Certification courses are readily available through agencies such as PADI, American Red Cross, or Divers Alert Network (DAN).

Cardiopulmonary resuscitation (CPR) involves a combination of mouth-to-mouth rescue breathing and chest compression. CPR keeps oxygenated blood flowing to the brain and other vital organs until appropriate medical treatment can restore a normal heart rhythm.

Rescue Breathing. Mouth-to-mouth rescue breathing is the quickest way to get oxygen into a person's lungs. However, if you're not trained in emergency procedures, doctors recommend skipping mouth-to-mouth rescue breathing and proceeding directly to chest compression. The reason is that if trying to perform unfamiliar breathing techniques distracts you, valuable lifesaving minutes might be lost for the person who needs help. The most important thing you can do is to proceed directly to chest compression to move blood to vital organs, particularly the brain and heart. If you're trained in emergency procedures, it's important to do both mouth-to-mouth rescue breathing and chest compression.

Chest compression. Chest compressions replace the heartbeat when it has stopped. Compressions help maintain some blood flow to the brain, lungs and heart. You must perform rescue breathing anytime you perform chest compressions.

Before starting CPR, assess the situation:

Is the person conscious or unconscious?

If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

If the person doesn't respond, follow the steps below and get help by dialing 911 or calling for emergency medical assistance. If you can't leave the scene, have someone else call.

To perform CPR:

1. Position the person so you can check for signs of life by laying the person flat on their back on a firm surface and extending the neck.
2. Open the person's mouth and airway by lifting the chin forward.
3. Determine whether the person is breathing by simultaneously listening for breath sounds, feeling for air motion on your cheek and ear, and looking for chest motion.
4. If the person is not breathing, pinch his or her nostrils closed, make a seal around the mouth and breathe into his or her mouth twice. Give one breath every five seconds — 12 breaths each minute — and completely refill your lungs after each breath.
5. If there are no signs of life — no response, movement or breathing — begin chest compressions. Place your hands over the lower part of the breastbone, keep your elbows straight and position your shoulders directly above your hands to make the best use of your weight.
6. Push down 1 1/2 to 2 inches at a rate of 80 to 100 times a minute. The pushing down and letting up phase of each cycle should be equal in duration. Don't jab down and relax. After 15 compressions, breathe into the person's mouth twice.
7. After every four cycles of 15 compressions and two breaths, recheck for signs of life. Continue the rescue maneuvers as long as there are no signs of life.

The above is just a brief description of CPR and is not intended for instructional use on how to provide CPR. To learn CPR, it is highly recommended that you take a first-aid training course.

Compressors

For safety reasons only properly trained and competent people should operate compressors. If you use a portable gas or diesel engine take care not to have the air intake in a place where fumes may be ingested with the air, and never use the compressor in a site where it is an annoyance to other people. It is essential that air of a high standard of purity be delivered. The production of compressed air for use in oxygen-enriched mixtures requires specialized oil-free equipment and training. Only properly trained operators using appropriate equipment should undertake this. (See Nitrox)

The compressed air must meet local scuba diving air quality and testing standards. If no local standards exist, the compressed air must meet the Compressed Gas Association (CGA), Table 1, Level E Standards for Scuba Diving Air as shown below.



Computers

Dive computers offer accurate and automatic recording of depth and time and continuously calculate the diver's No-Decompression Limits (NDL) according to the depth and duration of the dive. Computers are also available with advanced features such as the ability to calculate NDL’s for a variety of Nitrox mixes and mixed gases, and also to monitor available air and air consumption rates. The use of a dive computer is no substitute for proper dive planning, including proper attention to air requirements and dive time. It is recommended that divers choose a computer that is at least as conservative as the PADI Recreational Dive Planner on a rectangular dive profile. Individual susceptibility to decompression illness varies and can be affected by a number of factors, for which no computer or dive table is able to allow.

Divers should be aware of this and avoid pushing computers beyond their limits. The advice on safer diving attached to use of the Recreational Dive Planner applies equally to computer users and should be followed. (See PADI Recreational Dive Planner)

Cylinders (Air)

Air Cylinders or tanks are one of your most important pieces of dive equipment. Scuba tanks or cylinders allow the diver to have his or her own source of air. The tank is a cylinder container made from steel or aluminum. Scuba tanks can be short and fat or long and skinny. Scuba tanks hold different amounts of air. Since tanks contain air stored under high pressure, proper care and maintenance of club tanks must be adhered to when handling them.

Cylinder testing is a legal requirement and you will find it extremely hard to get an air fill unless your cylinders pass testing. There are two types of mandatory test:
1.Hydrostatic - this is a Federally mandated test, DOT regulations (Title 49, CFR 302), that must be undertaken every 5 years and includes pressure testing of the cylinder. Cylinders are ‘die’ stamped with the month and year of their last successful test on the shoulder of the cylinder.
2.Visual - this is a mandatory visual inspection both externally and internally every year. A label is attached to the tank side to indicate when the next inspection is due.

All Hoofer SCUBA Club tanks are visually inspected every year by a qualified inspector. Any club tanks that are due to be hydrostatically tested are done so immediately when their stamps indicate it is necessary.

Be sure not to drop your cylinder particularly on the valves. Lie cylinders down whenever unattended and make sure they can’t roll. Filled tanks should never be left in direct sunlight, or in a hot car trunk. Excessive heat can expand the air inside the tank and cause a rupture of the burst disc. The heat can also weaken the metal and shorten the life of the tank.

Tanks should never be filled over their capacity. This is both illegal and dangerous. Should this happen to a tank you use it's a good idea to notify the dive shop of their mistake, and in extreme situations like a 20% overfill, have the dive shop send the tank in for another hydro, but make certain that they pay for the test.

Cylinders (Argon)

Argon suit inflation systems are used with dry suits in colder climes or when using breathing gases which include Helium. Helium readily transmits heat away from the body; in fact it is six times more conductive than air, using a helium mix for suit inflation risks hypothermia and mental impairment due to the debilitating effects of cold on the body.

Argon can be used to increase thermal protection by up to 40%, compared to air. It is widely available and is the gas of choice for this purpose.

Argon cylinders must be visibly marked to indicate that they contain argon and not breathing gas. Inadvertently breathing argon can lead to unconsciousness and DEATH!

Argon regulators consist of a first stage, a low pressure dry suit inflation hose and an over-pressure relief valve (OPV).

First stages should be fairly robust and function well at low intermediate pressures. Generally cheaper first stages can be used, since they don't necessarily need to be balanced. Argon regulators have to be fitted with an OPV since there is no second stage through which gas can freeflow in the event of a failure.

Cylinders (Nitrox and Mixed Gas)

Cylinders for use with Nitrox and Mixed Gas should be dedicated to this use, marked with a suitable label that clearly identifies the gas mixture contained (oxygen percentage) and the Maximum Operating Depth (MOD).

Cylinders should be regularly (usually annually) cleaned to oxygen service standard. Oxygen service standard is essential where the oxygen content is 23% or greater and the cylinder is likely to be filled using pure oxygen and the partial pressure method. Nitrox cylinders should have a maximum working pressure of 3000 psi. Cylinder contents should always be analyzed at the time of filling and again immediately prior to the dive (See Nitrox and Compressors)