Your DAN Safety Stop 2019 Q2

Perspective
CULTIVATING A CULTURE OF DIVE SAFETY
Throughout it’s history, DAN has led the movement to promote diver health and safety, actively campaigning industry stakeholders and engaging communities around the world to advance safe practices. During this time almost every facet of recreational diving has evolved... it’s now time to evolve how the industry responds to dive incidents.
We are taking the next step and working directly with you to offer the education, training and resources needed to build safer dive communities around the world.
Through new and utilising existing programs, services and resources, DAN has developed a modern, multifaceted approach to preventing and responding to emergencies.
We are taking the next step and working directly with you to offer the education, training and resources needed to build safer dive communities around the world.
Through new and utilising existing programs, services and resources, DAN has developed a modern, multifaceted approach to preventing and responding to emergencies.
FOR NEARLY 40 YEARS, DAN HAS BEEN HERE FOR YOU.
DAN’s medical services are available to recreational divers, dive professionals and health-care providers of every level. We offer physician education, an emergency hotline, medical information and consultation, educational programs and a worldwide referral network of doctors who treat or evaluate divers. The DAN Emergency Hotline is staffed by doctors, nurses, paramedics and emergency medical technicians who are on call 24 hours a day, 365 days a year to provide information, coordinate care and facilitate evacuations.
1. CALL
We get the call. It might be from a diver, a traveler, a friend or a physician. But regardless, someone needs medical attention and they need our help. DAN medics are on call 24/7 ready to assist and can engage with our on-call physician if needed.
2. RESPOND
An immediate course of action is recommended, including first-aid if needed. If local emergency medical services (EMS) has yet to be activated, the caller is instructed to do so.
3. PLAN
A protocol for staying in contact is established. The DAN medic and the caller work together to make a plan to get the patient necessary medical care.
4. EVACUATE
Not all injuries can be treated locally. If evacuation is required, DAN organises an emergency evacuation to ensure the patient receives necessary care.
5. FOLLOW-UP
Throughout the incident, the DAN team remains in contact with the caller and patient, inquiring about the patient’s condition, providing updates regarding evacuation, and remaining available to provide support.
6. MONITOR
Maintaining frequent contact, the DAN team monitors definitive care and medical evacuation progress. If insured, DAN’s insurance professionals join the patient’s support team.
7. CONCLUDE
From the time we get the call until the patient is discharged, DAN is there. Whether you’re a diver, a traveler or both, we’re here for you.
Second Quarter Round-Up!
Phew! This year is going by faster than anybody can say 3..2…1…go!
After lazing about at the Port Elizabeth dive festival things just picked up speed. Nicky Olckers one of the DAN representatives was fortunate to have the opportunity to visit Nosy Be (Madagascar) and stay at Sakatia Lodge. She was extravagantly spoiled with diving on most days and taken to see some of the tourist sites around Nosy. The water was clear and the seas flat that made for excellent diving. She received world class treatment during her stay at Sakatia Lodge. The main reason for her visit was to promote the different DAN services and build stronger relationships with the dive industry. The DAN workshop at the chamber facility was well supported by the Nosy Be dive industry and finished with a dry dive under control by Jose Vieira from Sakatia Lodge who maintains the chamber facility. After her return to South Africa Nicky spent some time at the DAN office in Johannesburg before catching up on her Social Media duties that helps spread DAN awareness.
After lazing about at the Port Elizabeth dive festival things just picked up speed. Nicky Olckers one of the DAN representatives was fortunate to have the opportunity to visit Nosy Be (Madagascar) and stay at Sakatia Lodge. She was extravagantly spoiled with diving on most days and taken to see some of the tourist sites around Nosy. The water was clear and the seas flat that made for excellent diving. She received world class treatment during her stay at Sakatia Lodge. The main reason for her visit was to promote the different DAN services and build stronger relationships with the dive industry. The DAN workshop at the chamber facility was well supported by the Nosy Be dive industry and finished with a dry dive under control by Jose Vieira from Sakatia Lodge who maintains the chamber facility. After her return to South Africa Nicky spent some time at the DAN office in Johannesburg before catching up on her Social Media duties that helps spread DAN awareness.
WHY DO ENTRY-LEVEL STUDENTS NEED DIVE COVER?
Life happens… While learning to dive is relatively safe, there are inherent risks. From minor injuries such as ear issues or a slip-and-fall to more serious dive related injuries, this coverage helps ensure new divers can learn confidently knowing they are protected.
Some health insurance plans exclude coverage for adventure sport and scuba diving injuries. Others may have large deductibles or co-pays for treatment. DAN’s program pays 100% of covered medical expenses.
As entry-level divers, students are often not aware of all the safety aspects and possible risks associated with diving. To cater specifically for these needs, DAN has developed the Student membership package. Instructors can ensure their students are safe from their very first breath as divers.
Why do entry-level students’ divers need cover? Instructors have asked why students should have DAN cover since they are not exposed to the same diving risks as certified divers. DAN offers (complementary) cover to student divers because their risk is indeed much lower. However, injuries can still occur during instruction. In fact, according to DAN’s annual report on Decompression Illness and Diving Fatalities, student injuries have been the third and fourth leading diving activity associated with diving injuries during the past several years.
Did you know that the entry-level dive cover is free? Yes it is true! As long as the instructor is an active DAN member. DAN Student membership offers entry-level divers’ emergency medical benefits for the duration of their entry-level training. It provides up to R300,000 emergency medical service benefits at no cost to the diver or the instructor who teaches them. It is about providing peace of mind to students and instructors alike.
How are students enrolled? Instructors need to sign up their students at the beginning of a course. Instructors can apply online or even download the application form for the Student Membership from the DAN website or use the DAN mobile App available via the Google Play Store or the Apple App Store. Upon qualifying, we hope that newly-certified divers will realise the benefits of becoming full DAN members. Upon receipt of a student’s registration, both the student and the instructor will receive, via email, a confirmation of registration and the student’s new student member number.
Kudos to the following dive instructors that made use of the Student membership programme on a regular bases during the past months. We take note and recognise their consistent work.
To name but a few. To all of the dive instructors in the DAN Southern Africa region, thank you for introducing your students to diving and doing it as safe divers. Remember it is Your Adventure! Your Safety!
Another first for Nicky was visiting Mauritius. She was introduced to this super friendly dive destination on arrival. Through several meetings with the members of the Mauritius Scuba Diving Association (MSDA) she was able to make new friends and partnerships on the Island. The lively bunch from Mauritius underwater Group had a lot of questions and a super welcoming BRAAI (Barbecue)!
At present Nicky is visiting many of the dive resorts along the Mozambican coastline. After she returns from Mozambique she will make a quick stopover at the DAN office before traveling to Zanzibar at the end of August to continue growing DAN awareness and fostering relationships with the local dive industry.
Some health insurance plans exclude coverage for adventure sport and scuba diving injuries. Others may have large deductibles or co-pays for treatment. DAN’s program pays 100% of covered medical expenses.
As entry-level divers, students are often not aware of all the safety aspects and possible risks associated with diving. To cater specifically for these needs, DAN has developed the Student membership package. Instructors can ensure their students are safe from their very first breath as divers.
Why do entry-level students’ divers need cover? Instructors have asked why students should have DAN cover since they are not exposed to the same diving risks as certified divers. DAN offers (complementary) cover to student divers because their risk is indeed much lower. However, injuries can still occur during instruction. In fact, according to DAN’s annual report on Decompression Illness and Diving Fatalities, student injuries have been the third and fourth leading diving activity associated with diving injuries during the past several years.
Did you know that the entry-level dive cover is free? Yes it is true! As long as the instructor is an active DAN member. DAN Student membership offers entry-level divers’ emergency medical benefits for the duration of their entry-level training. It provides up to R300,000 emergency medical service benefits at no cost to the diver or the instructor who teaches them. It is about providing peace of mind to students and instructors alike.
How are students enrolled? Instructors need to sign up their students at the beginning of a course. Instructors can apply online or even download the application form for the Student Membership from the DAN website or use the DAN mobile App available via the Google Play Store or the Apple App Store. Upon qualifying, we hope that newly-certified divers will realise the benefits of becoming full DAN members. Upon receipt of a student’s registration, both the student and the instructor will receive, via email, a confirmation of registration and the student’s new student member number.
Kudos to the following dive instructors that made use of the Student membership programme on a regular bases during the past months. We take note and recognise their consistent work.
- Elton Polly from Go Dive Mosselbay,
- Reel van der Merwe, Gardenroute scuba,
- Keith Henderson, 2Dive4 scuba,
- Stephen Berriman, Spalsh H2O
- Jaco de Klerk,
- Chris Steenkamp, Dantica Diving Windhoek,
- Cholo Mkubwa, Fun Divers Zanzibar,
- Clare from Aliwal shoal dive Charters
To name but a few. To all of the dive instructors in the DAN Southern Africa region, thank you for introducing your students to diving and doing it as safe divers. Remember it is Your Adventure! Your Safety!
Another first for Nicky was visiting Mauritius. She was introduced to this super friendly dive destination on arrival. Through several meetings with the members of the Mauritius Scuba Diving Association (MSDA) she was able to make new friends and partnerships on the Island. The lively bunch from Mauritius underwater Group had a lot of questions and a super welcoming BRAAI (Barbecue)!
At present Nicky is visiting many of the dive resorts along the Mozambican coastline. After she returns from Mozambique she will make a quick stopover at the DAN office before traveling to Zanzibar at the end of August to continue growing DAN awareness and fostering relationships with the local dive industry.
Safety Tips from the DAN Medics
IN PREPARATION FOR YOUR NEXT DIVING HOLIDAY, DAN HAS DEVISED A FEW HELPFUL TRAVEL SAFETY TIPS TO ENSURE YOU MAKE THE MOST OUT OF YOUR TRIP.
As DAN members embark on their dive getaways for the holidays, there are important safety tips every diver needs to take into consideration. We present these tips, adding our own DAN twist to a few pointers mentioned in Baz Luhrmann’s ever-popular sunscreen song, “Everybody’s Free (to Wear Sunscreen)”.
Use sunscreen: The long-term benefits of sunscreen have been proven by scientists.
Enjoy your youth: Dive, travel and dive some more, and become oblivious to the wrinkles you may imprint from squinting into the sun and from the salty water. Trust us, when your youth has faded, you’ll look back at photos and fondly recall each twinge of excitement you felt, grasping onto the hopes of seeing that whale shark, coelacanth, dugong or great white.
Don’t worry: DAN is your buddy. Be sure to check that your membership status is active and keep the DAN hotline number handy for medical advice, which is available 24/7/365 worldwide. Don’t forget to activate roaming on your cell phone.
Don’t be reckless: Don’t put up with people who are reckless with your life. Stretch: Rest after a dive, relax and take in the breeze… ah, enjoy life!
Travel: Don’t feel guilty to travel the world and dive in exotic places.
Be kind to your knees: Keep in shape and be fit for that swim in the ocean current. Have your regular check-ups with your dive physician, and follow his or her advice with regard to medication and diving.
Read the map directions: Familiarise yourself with your surroundings and what emergency resources are available in the area. Choose a DAN Dive Safety Partner as your guide.
Accept certain inalienable truths: Never bolt to the surface and hold your breath. Contrary to belief, you are not a fish; you need your lungs. An arterial gas embolism is not a pretty friend. Be sure to stick to your dive tables to plan a safe dive. If you develop tingles, dizziness or other symptoms, remain calm and call the hotline to have them checked.
Don’t mess too much with your ears: Equalise early and often to protect your delicate tympanic membranes (eardrums). You’ll need these organs well into your geriatric years – how else will you hear your great-grandchildren? Don’t forget to equalise your mask – no need to look like a red-eyed Dracula!
Be careful whose advice you buy: Take a refresher course if you are out of practise, revise skills and boost your confidence. Be current with your CPR and first aid skills and make sure you’re able to offer assistance to a fellow diver or buddy in need, whether it’s neuro assessments, hazardous marine life injury treatments or oxygen administration. Remember to supply oxygen first when DCI is suspected.
Don’t rely on luck: Protect yourself against malaria, as well as other bites, stings and tricky encounters with venomous creatures under and above the water. Water: Make sure you are well hydrated. Remember, alcohol and diving don’t mix.
But whatever you do – trust us on the sunscreen…
As DAN members embark on their dive getaways for the holidays, there are important safety tips every diver needs to take into consideration. We present these tips, adding our own DAN twist to a few pointers mentioned in Baz Luhrmann’s ever-popular sunscreen song, “Everybody’s Free (to Wear Sunscreen)”.
Use sunscreen: The long-term benefits of sunscreen have been proven by scientists.
Enjoy your youth: Dive, travel and dive some more, and become oblivious to the wrinkles you may imprint from squinting into the sun and from the salty water. Trust us, when your youth has faded, you’ll look back at photos and fondly recall each twinge of excitement you felt, grasping onto the hopes of seeing that whale shark, coelacanth, dugong or great white.
Don’t worry: DAN is your buddy. Be sure to check that your membership status is active and keep the DAN hotline number handy for medical advice, which is available 24/7/365 worldwide. Don’t forget to activate roaming on your cell phone.
Don’t be reckless: Don’t put up with people who are reckless with your life. Stretch: Rest after a dive, relax and take in the breeze… ah, enjoy life!
Travel: Don’t feel guilty to travel the world and dive in exotic places.
Be kind to your knees: Keep in shape and be fit for that swim in the ocean current. Have your regular check-ups with your dive physician, and follow his or her advice with regard to medication and diving.
Read the map directions: Familiarise yourself with your surroundings and what emergency resources are available in the area. Choose a DAN Dive Safety Partner as your guide.
Accept certain inalienable truths: Never bolt to the surface and hold your breath. Contrary to belief, you are not a fish; you need your lungs. An arterial gas embolism is not a pretty friend. Be sure to stick to your dive tables to plan a safe dive. If you develop tingles, dizziness or other symptoms, remain calm and call the hotline to have them checked.
Don’t mess too much with your ears: Equalise early and often to protect your delicate tympanic membranes (eardrums). You’ll need these organs well into your geriatric years – how else will you hear your great-grandchildren? Don’t forget to equalise your mask – no need to look like a red-eyed Dracula!
Be careful whose advice you buy: Take a refresher course if you are out of practise, revise skills and boost your confidence. Be current with your CPR and first aid skills and make sure you’re able to offer assistance to a fellow diver or buddy in need, whether it’s neuro assessments, hazardous marine life injury treatments or oxygen administration. Remember to supply oxygen first when DCI is suspected.
Don’t rely on luck: Protect yourself against malaria, as well as other bites, stings and tricky encounters with venomous creatures under and above the water. Water: Make sure you are well hydrated. Remember, alcohol and diving don’t mix.
But whatever you do – trust us on the sunscreen…
Frequently Ask Questions
Question: Lately I feel like I'm getting sunburned much more easily than I used to. I am taking a new medication; is there any chance that could be the cause?
Answer: Sunshine is a welcome addition to just about any day spent outdoors. For many people, a hat, a T-shirt and some sunscreen are sufficient to limit the negative effects of sun exposure.
Certain medications, however, can make people more sensitive to the sun's ultraviolet (UV) rays; this is called photosensitivity. Both regularly and temporarily used medications can cause photosensitivity. Minor symptoms include skin reddening, itching or rash; more serious symptoms include a burn, blisters and discoloration or darkening of the skin. Report any significant or unusual reaction to a medication combined with sun exposure to your prescribing or primary care physician. Some reactions are serious.
There are more than 100 medications, both prescription and over-the-counter, that can cause increased susceptibility to UV rays, and these include both oral and topical medications. The best policy is to first read the label of any medication you take and then ask your physician and/or pharmacist about photosensitivity before exposure to the sun (or a tanning bed).
Drugs that may cause photosensitivity include antibiotics, antihistamines, cardiovascular medications (such as diuretics and blood pressure medications), nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin), some antidepressants and some antipsychotic medications.
Taking a medication that can cause photosensitivity doesn't mean you have to avoid outdoor activities, it just means you should take extra precautions to lessen your exposure to UV light. Consider wearing a wide-brimmed hat, long sleeves and long pants, and reapply your sunscreen more frequently. Stay indoors around mid-day if possible, and seek shade when you're outside.
Do you have a question for the DAN medical team? Use the form below to submit your question.
Answer: Sunshine is a welcome addition to just about any day spent outdoors. For many people, a hat, a T-shirt and some sunscreen are sufficient to limit the negative effects of sun exposure.
Certain medications, however, can make people more sensitive to the sun's ultraviolet (UV) rays; this is called photosensitivity. Both regularly and temporarily used medications can cause photosensitivity. Minor symptoms include skin reddening, itching or rash; more serious symptoms include a burn, blisters and discoloration or darkening of the skin. Report any significant or unusual reaction to a medication combined with sun exposure to your prescribing or primary care physician. Some reactions are serious.
There are more than 100 medications, both prescription and over-the-counter, that can cause increased susceptibility to UV rays, and these include both oral and topical medications. The best policy is to first read the label of any medication you take and then ask your physician and/or pharmacist about photosensitivity before exposure to the sun (or a tanning bed).
Drugs that may cause photosensitivity include antibiotics, antihistamines, cardiovascular medications (such as diuretics and blood pressure medications), nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin), some antidepressants and some antipsychotic medications.
Taking a medication that can cause photosensitivity doesn't mean you have to avoid outdoor activities, it just means you should take extra precautions to lessen your exposure to UV light. Consider wearing a wide-brimmed hat, long sleeves and long pants, and reapply your sunscreen more frequently. Stay indoors around mid-day if possible, and seek shade when you're outside.
Do you have a question for the DAN medical team? Use the form below to submit your question.
Incident Insight
THE STORY OF A RASH AFTER A DIVE BY DR GARY MORRIS
Skin problems in diving can have various causes, including decompression illness. In this article, we look at the different forms of skin bends and what to do when you think you might be affected.
WHAT HAPPENED?
The diving and visibility had been good and the filming of marine ecosystems was progressing well, but deadlines had to be met, so every opportunity to get shots had to be taken. For the last 10 days, diving had taken place with two or three dives daily, each lasting 45 to 60 minutes. Diving depths were up to 20 m with a lot of variation in depth – going up to get a better view and then down again to assist in another aspect of the work. This required a lot of physical work. The divers were experienced, having done “thousands” of dives in many locations around the world. The area where they were diving, on the coast of South Africa, was very familiar and they knew the conditions. Some of the divers on the team had been ill and could not dive, so the other team members were working harder to get things done. They were fit and healthy, but starting to tire after this intense period of work.
The first dive of this particular day was to a maximum of 18 m and lasted about an hour. The day was beautifully calm and warm. The divers surfaced and one of the most experienced in the group felt pain in her right shoulder on removing her wetsuit. She developed itching, swelling, mottling and a purple-red discolouration of the skin on her upper arm. Other than that, she felt well and had no tingling in her hands and feet, no weakness, no headache or confusion, and she did not feel breathless. She was given oxygen for about 30 minutes and one hour after surfacing, the symptoms had markedly decreased.
THE DIAGNOSIS
The diver and her companions suspected decompression illness (DCI) and contacted the DAN hotline. They were advised to see a local diving doctor to treat possible skin bends. They reached the doctor’s rooms about two hours after surfacing. By that time the symptoms had almost gone, although mild pain persisted in her upper arm.
There was still slight swelling, mottling and redness of her upper arm. Her shoulder was mildly tender, but had its full range of movements. No neurological, chest, heart or other abnormalities were found. A diagnosis of Type 1, pain only, DCI with skin involvement was made. As the symptoms had mostly resolved and there were no signs of neurological involvement (Type 2 DCI), she was treated with a further hour of surface oxygen and given aspirin for the pain. She went home to rest with the instructions to ensure adequate fluid intake and to contact the doctor if any other symptoms developed. She was not permitted to dive for the next seven days. The mild pain and rash persisted for a few days, after which she returned to active diving free of symptoms.
WHAT ARE "SKIN BENDS" (Cutaneous Decompression Sickness)?
Skin problems in diving can have various causes, including DCI, but rashes and itchiness can also be caused by stings from jellyfish, bluebottles, coral and the spines of sea urchins and various fishes. Suit squeeze or an allergic reaction to the neoprene in wetsuits will cause a rash, pain or itchiness in a pattern resembling the folds and seams of the suit.
DCI with skin manifestations can vary from mild swelling and itching confined to a small area to more widespread and dangerous rashes and mottling that could signal a more serious underlying problem.
Itchiness with no rash
There are many causes for itchy skin after diving. However, where this occurs after chamber or dry suit diving, it may be due to a highly localised form of decompression sickness (DCS). This type is not associated with other systemic manifestations. It is probably due to gas passing into the skin from the high pressure gas surrounding it.
The cause of the itch is thought to be the formation of small bubbles in the epidermis with the release of pressure. The symptoms are mild, temporary itching. No signs can be seen on the skin. The areas most affected are the forearms, wrists, hands, nose and ears. No treatment is needed.
Scarlatiniform rash
This presents as a flat, itchy rash, mainly over the chest, back, shoulders or thighs. The rash appears similar to sunburn. It is also caused by bubble formation in the skin, with the release of histamine and other chemicals. The rash is not associated with any other manifestations of DCI, apart from pain. It clears with oxygen treatment or spontaneously in a few hours. Recompression is usually not needed unless the rash progresses to the more serious form or neurological symptoms develop.
Marbling of skin (cutis marmorata)
This is a serious form of skin bends and looks mottled, with various shades of bright red, purplish or even bluish skin, with an uneven, marble-like pattern. Swelling occurs and the skin takes on an “orange-peel” appearance. The skin can be very itchy and irritated at first. It is also most common on the torso, shoulders and thighs. The colouration may appear in patches or in severe cases may begin on the chest and spread downwards. The signs on the skin indicate what is happening elsewhere in the body. Gas bubbles are found in the skin, underlying tissue and blood vessels. This is a serious condition and is usually found in conjunction with neurological DCI. A diver with this condition requires recompression.
WHAT IS THE SIGNIFICANCE OF SKIN BENDS?
Skin bends can indicate underlying or developing serious decompression problems
Cutaneous DCS symptoms have been known to manifest before or along with the symptoms of more serious types of DCS, such as neurological DCS. The sooner a diver gets help, the greater the chances of a full recovery. Recognising a skin bend may be the first step to timeous and effective treatment.
Skin bends may indicate a patent foramen ovale
A patent foramen ovale (PFO) is a heart condition that is thought to increase the risk of serious DCI. There appears to be a correlation between skin bends from dives well within the recreational dive tables and the presence of a PFO. Divers who have a history of undeserved skin bends are advised to seek the opinion of a diving doctor.
WHAT TO DO WHEN YOU THINK YOU HAVE SKIN BENDS
Whatever the cause, either the depth or duration of the dive, skin bends usually appear within a few minutes to a few hours after surfacing. If you notice or develop a problem with your skin after a dive, follow the rule – it is a bend until proven otherwise. When a skin bend is suspected, the following should be done:
Skin problems in diving can have various causes, including decompression illness. In this article, we look at the different forms of skin bends and what to do when you think you might be affected.
WHAT HAPPENED?
The diving and visibility had been good and the filming of marine ecosystems was progressing well, but deadlines had to be met, so every opportunity to get shots had to be taken. For the last 10 days, diving had taken place with two or three dives daily, each lasting 45 to 60 minutes. Diving depths were up to 20 m with a lot of variation in depth – going up to get a better view and then down again to assist in another aspect of the work. This required a lot of physical work. The divers were experienced, having done “thousands” of dives in many locations around the world. The area where they were diving, on the coast of South Africa, was very familiar and they knew the conditions. Some of the divers on the team had been ill and could not dive, so the other team members were working harder to get things done. They were fit and healthy, but starting to tire after this intense period of work.
The first dive of this particular day was to a maximum of 18 m and lasted about an hour. The day was beautifully calm and warm. The divers surfaced and one of the most experienced in the group felt pain in her right shoulder on removing her wetsuit. She developed itching, swelling, mottling and a purple-red discolouration of the skin on her upper arm. Other than that, she felt well and had no tingling in her hands and feet, no weakness, no headache or confusion, and she did not feel breathless. She was given oxygen for about 30 minutes and one hour after surfacing, the symptoms had markedly decreased.
THE DIAGNOSIS
The diver and her companions suspected decompression illness (DCI) and contacted the DAN hotline. They were advised to see a local diving doctor to treat possible skin bends. They reached the doctor’s rooms about two hours after surfacing. By that time the symptoms had almost gone, although mild pain persisted in her upper arm.
There was still slight swelling, mottling and redness of her upper arm. Her shoulder was mildly tender, but had its full range of movements. No neurological, chest, heart or other abnormalities were found. A diagnosis of Type 1, pain only, DCI with skin involvement was made. As the symptoms had mostly resolved and there were no signs of neurological involvement (Type 2 DCI), she was treated with a further hour of surface oxygen and given aspirin for the pain. She went home to rest with the instructions to ensure adequate fluid intake and to contact the doctor if any other symptoms developed. She was not permitted to dive for the next seven days. The mild pain and rash persisted for a few days, after which she returned to active diving free of symptoms.
WHAT ARE "SKIN BENDS" (Cutaneous Decompression Sickness)?
Skin problems in diving can have various causes, including DCI, but rashes and itchiness can also be caused by stings from jellyfish, bluebottles, coral and the spines of sea urchins and various fishes. Suit squeeze or an allergic reaction to the neoprene in wetsuits will cause a rash, pain or itchiness in a pattern resembling the folds and seams of the suit.
DCI with skin manifestations can vary from mild swelling and itching confined to a small area to more widespread and dangerous rashes and mottling that could signal a more serious underlying problem.
Itchiness with no rash
There are many causes for itchy skin after diving. However, where this occurs after chamber or dry suit diving, it may be due to a highly localised form of decompression sickness (DCS). This type is not associated with other systemic manifestations. It is probably due to gas passing into the skin from the high pressure gas surrounding it.
The cause of the itch is thought to be the formation of small bubbles in the epidermis with the release of pressure. The symptoms are mild, temporary itching. No signs can be seen on the skin. The areas most affected are the forearms, wrists, hands, nose and ears. No treatment is needed.
Scarlatiniform rash
This presents as a flat, itchy rash, mainly over the chest, back, shoulders or thighs. The rash appears similar to sunburn. It is also caused by bubble formation in the skin, with the release of histamine and other chemicals. The rash is not associated with any other manifestations of DCI, apart from pain. It clears with oxygen treatment or spontaneously in a few hours. Recompression is usually not needed unless the rash progresses to the more serious form or neurological symptoms develop.
Marbling of skin (cutis marmorata)
This is a serious form of skin bends and looks mottled, with various shades of bright red, purplish or even bluish skin, with an uneven, marble-like pattern. Swelling occurs and the skin takes on an “orange-peel” appearance. The skin can be very itchy and irritated at first. It is also most common on the torso, shoulders and thighs. The colouration may appear in patches or in severe cases may begin on the chest and spread downwards. The signs on the skin indicate what is happening elsewhere in the body. Gas bubbles are found in the skin, underlying tissue and blood vessels. This is a serious condition and is usually found in conjunction with neurological DCI. A diver with this condition requires recompression.
WHAT IS THE SIGNIFICANCE OF SKIN BENDS?
Skin bends can indicate underlying or developing serious decompression problems
Cutaneous DCS symptoms have been known to manifest before or along with the symptoms of more serious types of DCS, such as neurological DCS. The sooner a diver gets help, the greater the chances of a full recovery. Recognising a skin bend may be the first step to timeous and effective treatment.
Skin bends may indicate a patent foramen ovale
A patent foramen ovale (PFO) is a heart condition that is thought to increase the risk of serious DCI. There appears to be a correlation between skin bends from dives well within the recreational dive tables and the presence of a PFO. Divers who have a history of undeserved skin bends are advised to seek the opinion of a diving doctor.
WHAT TO DO WHEN YOU THINK YOU HAVE SKIN BENDS
Whatever the cause, either the depth or duration of the dive, skin bends usually appear within a few minutes to a few hours after surfacing. If you notice or develop a problem with your skin after a dive, follow the rule – it is a bend until proven otherwise. When a skin bend is suspected, the following should be done:
- Give oxygen by mask.
- Note the distribution, time of onset and progress of the rash as well as the response to oxygen and the development of other symptoms.
- Contact the DAN hotline to discuss the symptoms and how to proceed.
DAN Shop

Every day, divers and emergency-response personnel around the world trust DAN’s oxygen units and first-aid kits to perform in an emergency. That’s because DAN’s products have been developed, tested and refined with input from leading doctors and researchers to meet the discriminating requirements of the diving community. Be ready to respond. Explore DANShop.co.za to make sure you are prepared with the latest safety equipment to effectively handle any dive emergency.
DAN Education
Whether it is being on the scene of an accident or witnessing a health-related emergency, most people will be involved in a crisis situation at some point in their lives. Are you prepared to help? Do you have the skills to respond quickly?
Developed by medical experts, DAN’s courses are easy to understand and designed to provide you with the skills and confidence you need to respond in emergency situations. DAN first aid courses prepare divers to manage injuries related to scuba diving. All courses meet the 2015 ILCOR and AHA CPR guidelines. The training can also extend to other environments. Isn’t it worth a few hours one evening or weekend to learn the skills that could save a life?
Developed by medical experts, DAN’s courses are easy to understand and designed to provide you with the skills and confidence you need to respond in emergency situations. DAN first aid courses prepare divers to manage injuries related to scuba diving. All courses meet the 2015 ILCOR and AHA CPR guidelines. The training can also extend to other environments. Isn’t it worth a few hours one evening or weekend to learn the skills that could save a life?
Alert Diver Magazine
Alert Diver is the dive industry’s leading publication. Featuring DAN’s core content of dive safety, research, education and medical information, each issue is a must-read reference, archived and shared by passionate scuba enthusiasts. In addition, Alert Diver showcases fascinating dive destinations and marine environmental topics through images from the world’s greatest underwater photographers and stories from the most experienced and eloquent dive journalists in the business.
Posted in Your Safety Stop
Categories
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March