Feature Stories

Getting Prepared to Get Back to Diving – Part 2

Preparation for Scuba Diving – Part 2

By Dan and Betty Orr

To be prepared for the diving portion of any travel, it is prudent to understand that an emergency has two components: physical and financial. Therefore, divers are advised to be fully insured and protected prior to any travel involving scuba diving. Although recreational scuba diving is an inherently safe sport, accidents do occur and those that do may require specialized treatment in a hyperbaric chamber. Treatment facilities are spread around the globe but treatment for pressure-related diving emergencies (arterial gas embolism and decompression sickness) may require specialized medical evacuation. The cost of medical evacuation and treatment can be staggering and financially devastating to the uninsured. Make sure that whatever specialized insurance coverage you choose, it covers the costs associated with medical evacuation to the nearest appropriate treatment facility as well as coverage for all necessary treatments. It is also extremely important that all divers be members of Divers Alert Network (DAN). Wherever you live and dive, there is a DAN representative organization there to help you (https://www.diversalertnetwork.org/about/international). Members of DAN have benefits of membership that include travel assistance benefits (emergency medical evacuation for diving and non-diving emergencies) and have access to a variety of specialized insurance products including diving accident insurance, trip insurance, life insurance and equipment insurance. Insurance is as necessary and essential for dive travel as your mask, fins and snorkel.

It is also wise for us to make sure that those that travel with us know how to access our insurance and evacuation information in case of the unlikely event that we are incapacitated.

As we prepare for our return to diving, we must be careful that our enthusiasm to return to the water doesn’t overtake our ability to use all the skills necessary to safely and enjoyably return to diving. Scuba diving is not, as the old saying goes, “like riding a bicycle.” We, therefore, must understand that a prolonged period with no diving means that our skills, especially the critical emergency skills, may have degraded over time.

Skill degradation refers to the loss, decay or deterioration of trained or acquired skills and knowledge after a period of non-use, in our case, non-diving. Skill degradation is a potentially serious issue and certainly problematic in situations where we may not use or practice our skills for extended periods of time. The old adage of “use it or lose it” certainly applies to diving skill degradation.

We know that many emergency situations are the result of a diver, even experienced divers, trying to manage too many things at one time. This condition, known as “task loading,” can occur to divers who have not been in the water in a prolonged period of time and can include, simply trying to get used to equipment you haven’t used in a long time, problems with getting properly weighted or neutrally buoyant, difficulty clearing your ears or the emotional stress of just being underwater again. The result is a condition called “perceptual narrowing” and it limits what we are able to perceive in times of stress and, in my mind, an even more critical condition known as “response narrowing.” Response narrowing is a condition that, when under stress, divers can only effectively use skills that have been recently practiced and reinforced.

Before making any recommendations on how we may safely return to the water after a long absence, we should address the concept of skill degradation, sometimes referred to as “skill decay or deterioration,” as a function of time. Many of our most critical diving skills, especially those necessary to manage a diving emergency, are complex psychomotor skills that, without frequent practice and reinforcement, degrade over time. While there is no published research or studies specifically addressing the degrading of critical skills in scuba diving, there are studies done on the loss of proficiency in complex psychomotor skills necessary to adequately perform emergency first aid, surgical and piloting skills as a function of time without practice.

There has been considerable research published on the evaluation and optimization of methods for maintaining or retraining skilled performance by the medical community, private and commercial pilots and the U.S. military. In research involving deterioration of skill performance in Paramedics, it was shown that Advanced Life Support (ALS) skills deteriorate significantly within six months following the paramedic’s completion of their training class. With third-year medical students, there was a significant decline in emergency skill performance after six weeks of non-use and nonpractice. When nurses were evaluated for the retention of Advanced Cardiac Life Support (ACLS) skills only 30% passed the skills test at three months and only 14% passed the skills test at twelve months. There is also a significant amount of research on skill degradation in pilots both civilian and military. Elements of pilot skill degradation, as a function of time without practice has been extensively evaluated. These studies involved both emergency procedures (combination of cognitive and psychomotor tasks) and flight control (primarily continuous psychomotor tasks). The results showed that both procedural and control skills deteriorated significantly after one to four months of inactivity. In studies involving U.S. Military Reservists, the correlation between skill retention and the length of non-practice or non-use interval was distinctly negative. That is, after more than 365 days of non-use or nonpractice, the average reservist was performing essential military skills at a significantly lower level than before the nonpractice interval.

Knowing that skill degradation is a function of time associated with non-use, think back to the scuba course you took where you learned the complex skills involved in diving or the last time you practiced critical diving skills necessary to successfully manage a situation underwater. From the moment you finished the course or last practiced your skills, your knowledge and skills began to degrade. This phenomenon is, unfortunately, a fact of life. But what can we do about it?  Safety conscious divers understand that, once our formal training is over, we have the responsibility to maintain our skills at a level where we can act and react with the speed and proficiency necessary to safely manage any situation.

Since it has been clearly demonstrated in numerous research studies that there is a direct correlation between the time away from using or practicing a skill and the amount of skill degradation, we must take steps to make sure that our ability to perform essential skills is at an optimal level before we return to the water. The amount of skill degradation will depend on a variety of factors that are almost impossible to measure and quantify. As mentioned previously, “Scuba diving is inherently safe, but it is very unforgiving of mistakes!” This saying is actually a modification of the motto of the famed Lafayette Escadrille in World War I. They had a sign over their Quonset hut in France that read, “Flying is inherently safe, but it is mercilessly unforgiving of mistakes!” As discussed previously, there are many parallels between flying and diving. Each require meticulous preparation and a thorough understanding of how to successfully manage situations in an environment that can be very unforgiving. And, in both flying and diving, it is certainly very bad to run out of air! International diver training organizations, dive centers and instructors understand the concept of skill degradation and introduce the concept to divers as part of their initial training. These groups also understand that sometimes divers need a formalized method of practicing diving skills in a safe and secure way under the supervision of training and qualified instructors. This is done through refresher training programs. The value of refresher training programs is that they provide a structured way for divers to refamiliarize themselves with diving equipment (including new innovations and equipment designs) and skill practice under the direct supervision of an experienced instructor. There are also other ways to refresh skills and knowledge if refresher programs are not available. Dive clubs may provide opportunities for organized pool practice sessions and even openwater dives structured to allow divers to re-familiarize themselves with their equipment and skills in a shallow, benign dive site. If these opportunities are not available, divers are encouraged to seek out dive locations that are shallow with plenty of bottom reference to practice their skills. In situations like this, divers are encouraged to have a surface float for additional safety and as a surface station to rest, if necessary.

Divers are always encouraged to dive in a slow and deliberate manner and not venture deeper until they are completely comfortable with their equipment and are confident in their skills before moving beyond shallow water. This, as you can imagine, will require a very capable and understanding diving companion.