by Annika Andresen
Header image courtesy of Jack Austin, Dive Tutukaka . Other photos courtesy of A. Andresen unless noted.
It’s pretty safe to say that 2020 wasn’t the year anyone was expecting.
You might have read on my social media recently that I have been cleared to dive! Eight months ago I experienced a concussion from a surfing accident. It’s been a long (and, at times, really frustrating) recovery as I learned how to let myself rest, but one of my biggest questions was, “How will this affect my diving?”
So I thought I would share my journey over the last eight months, including my injury, my rehabilitation, and things to be aware of when returning to diving.
Here in New Zealand, we had a quick government response toward COVID, going into an immediate one-month lockdown and another further three weeks under tight restrictions, and initially, New Zealand successfully stamped out the virus. The first weekend out after restrictions eased, there was an awesome east coast swell and I was dying to get back in the water. My boyfriend Josh and I met one of my best friends up north before heading out to the coast to catch some waves.
I will be the first to admit that the waves were quite steep and bigger than I was used to. As I stood up on my first wave, I fell forward over my board and into the water. As the wave crashed over me, the water slammed my head into the seafloor below, catching the sand bottom beneath my chin. At the same time, my board had flung around, and the rail of the board hit the back of my head, breaking the fiberglass.
Despite this, I was feeling quite relaxed knowing I could hold my breath for over three minutes. I thought to myself, “Ouch that hurt,” but then waited patiently for the wave to pass before coming to the surface. As I stood up in the surf, I felt slightly dizzy but not bad enough to put me off surfing. I signalled to Josh to keep an eye on me and I went back out to catch the next wave. Learning my lesson from before, I stayed in the white water, enjoying the freedom of being in the ocean. An hour later, we returned to the beach for a hot shower and headed home. It wasn’t until I woke the next morning that I realized something was wrong.
It felt like I had the worst hangover. My head felt like it was in a clamp that was crushing my brain. The room was spinning, and I struggled to walk, using the walls to support me. Later that day, I called one of my best friends to ask what I should do, and she urged me to go to the A&E (accident and emergency facility). There, the doctors diagnosed a concussion.
After a week off work, the vertigo and the clamp-crushing head pain had stopped, but I still had a constant headache, and my heart rate was all over the place. I walked to the top of my driveway and my heart rate peaked at 180bpm. I realized then that this wasn’t going to be an overnight fix.
What Is A Concussion?
A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
In the months following the injury, despite not having any alcohol, I felt like I had a constant hangover. A team from Advanced Personnel Management (APM) took on my case to help me recover while easing back into work. The biggest shock was my initial assessment at the physio. The first test: walk across the room and pick up a pen on the floor on the way. Easy right? Well, as soon as I tried to pick the pen up and stand up, I immediately fell over. The second test involved my having to follow the doctor’s pen with my gaze as he moved it back and forth in front of my eyes. Also easy right? I didn’t realise it, but my physio said I blinked constantly as I tried to follow the pen. This was because my brain couldn’t process all the information, and the blinking was a coping mechanism to give my brain a break.
Through these tests, I found I had lost all my balance, eye tracking was difficult, and the ability to process information decreased significantly. I couldn’t articulate my thoughts and had trouble speaking. My hearing was impacted, as I couldn’t tolerate any loud sounds or multiple people speaking, and I wasn’t able to regulate my heartrate: all as a result of a concussion. Being in a car at night-time when it was raining was my worst nightmare—moving bright lights and fast windshield wipers were not a good combination.
To assist my recovery, the team at APM gave me a pair of fancy earplugs, blue light glasses, and some exercises to do. The hardest part was to get the balance right between rest and activity, while letting my brain recover. If you know me, you will know I am not great at prioritising rest. I eased back into my work as an educator, starting with two hours, then four hours, and slowly getting to half days in schools. Loud classrooms and VR headsets proved a challenging setting, but the struggles were balanced by the fantastic support I had from the BLAKE team. I also found afternoon naps to be amazing!
Four months after the injury, I was able to work a full day, and my headaches were intermittent, only increasing if I did too much exercise or didn’t get enough rest. But then I wanted to see if I was able to get back in the water. This period had been my longest time out of the water since I learned to dive in 2013.
Diving After A Concussion?
I am no doctor and, to be honest, I really had no idea about the risks associated with scuba diving after a concussion, so I reached out to Dr. Simon Mitchell to hear his thoughts. For those who don’t know him, Dr. Mitchell, is an incredible physician specialising in occupational medicine, hyperbaric medicine, and anaesthesiology, as well as being someone who is highly respected in the global diving community. He has a Wikipedia page and received the Rolex Diver of the Year Award in 2015. I felt so honoured that he emailed back and agreed to catch up. Trying not to be a fangirl, I was grateful for the facemask hiding my massive smile and excitement as I met Simon outside Auckland Hospital.
We discussed my injury and the symptoms associated with my concussion. I had not lost consciousness nor had I experienced any amnesia; therefore, my injury was classified as a mild concussion. Injuries with a loss of consciousness for 30 minutes to 24 hours or a skull fracture are considered moderate. Severe concussions are injuries that include loss of consciousness or amnesia for more than 24 hours, subdural hematoma, or brain contusion. I consider myself very lucky that my concussion was only mild.
There is little known about concussions, and research in this area is difficult, as every injury is so different. Although Simon explained that one of the major risks for scuba diving after a concussion was an increased risk of seizures, this risk varies according to the severity of the traumatic brain injury and is reflected in the correlation between trauma and seizures.
We did a couple of tests, focusing on my balance by standing with one foot in front of the other, with my hands on my shoulders, and with my eyes closed for one minute. I had been practicing my physio exercises every day and was stoked that I completed the one minute without falling over!
Despite having only a mild concussion, there was still a small increased risk of a seizure. Simon acknowledged that no one can ever guarantee that there will be no problems, so I accepted the unknown (but almost certainly small) degree of increased risk, and Simon gave me some advice to help me ease back into diving.
The first precaution was to understand which gas I was breathing. Increased partial pressures of oxygen can be known to increase the risk of seizures; therefore instead of diving nitrox, diving with air at 21% oxygen was recommended while I eased back into diving. Avoiding physical exertion and task loading on a dive—swimming into a strong current, instructing and guiding diving, or any activities that would raise my heart rate and increase symptoms—was also suggested. And finally, Simon’s last piece of advice was not to push depth for the first couple of months; instead to stick to open water dives (shallower than 18 m/60 ft).
But this meant I could dive again!!! And I was very, very excited about this. We concluded our catch up with epic diving stories and some amazing photos that Simon had taken on his incredible journeys on different diving expeditions.
Cleared to Dive!
Being cleared to dive, I eagerly called a couple of my friends and asked if they would join me for my first dive back. We chose to dive at Goat Island, New Zealand’s first marine reserve, and where my open water course was held.
We hit a maximum depth of 5 m/16 ft for an hour as I enjoyed being back in the water, chasing fish, looking for crayfish, and following Steph’s trusty navigation. It was so good to get back in the water, just in time for summer.
It has been three months since my first dive back in the water. If you follow my social media, you will know that over the summer, every spare minute I have is normally spent being on or in the water. I have been very lucky to have two weeks off work where I got to explore unfamiliar territory in the cooler waters of Waihau Bay, the most eastern part of New Zealand. And, although I wasn’t scuba diving there, it was great for freediving practice and just being back in the water. The second week of my holidays was spent in my favourite place up north in the sunny Tutukaka, where I have been able to scuba dive as much as I can while sticking to Simon’s advice and slowly increasing my depth.
For the first couple of months, I limited my dives to a maximum depth of 18 m/60 ft, avoiding physical excursion. During the last couple of weeks I have been increasing my depth limit to 30 m/98 ft, constantly monitoring how I am feeling and if any symptoms recur. I have been ensuring as well to make sure I drink plenty of water and allow for more rest and sleep than usual, both before and after diving.
Last weekend was a great test to see how I was after a full weekend of diving at the Mokohinau Islands. I completed four dives, my longest being 71 minutes, and loved every moment of it! We saw bronze whaler sharks, pilot whales, dolphins, a baby octopus, a little blue cod (unusual for this area), hundreds of schooling koheru, and a silver and yellow bait fish. The excitement I felt and the smiles on my face didn’t stop the whole weekend.
My next step in the next couple of months is to start diving with nitrox and work towards more technical diving later on in the year. Hopefully, by that stage, I will be able to travel and will be ready to take Global Underwater Explorers (GUE) Tech 1 and Cave 1 courses.
This is my own personal account of my injury. I wanted to share my experience and some scuba diving precautions after a concussion. If you have had a traumatic brain injury, no matter how slight, be sure to seek medical advice and clearance before returning to diving.
GUE’s first NEXTGen scholar, Annika Andresen is a virtual reality environmental educator for BLAKE NZ, connecting thousands of young Kiwis with their marine environment. Annika holds a Master of Architecture degree, where her thesis investigated the role architecture plays on the connection people have with their environment. During her studies, Annika worked as a dive instructor for Dive! Tutukaka, and was the President of the Auckland University Underwater Club. Annika has just been awarded the New Zealand Women of Influence Youth Award for 2019. Using her natural enthusiasm and infectious personality, Annika hopes to educate others to understand and cherish our unique environment and to better protect it for the years to come.
Who You Gonna Call (in an Emergency)?
In the immediate aftermath of a diving fatality, law enforcement needs to locate an emergency contact for the accident victim. If that person’s phone is locked, social media accounts private, and there’s no emergency contacts for friends or family, it will likely fall to you as a dive buddy, to locate the needed critical information. This can add unbearable stress to an already bad situation. The solution is to be prepared, as Buck Buchanan and Wally Endres with Christine Tamburri and Robert Zink explain.
by Buck Buchanan and Wally Endres with Christine Tamburri and Robert Zink. Images courtesy of the authors unless noted.
According to the 2020 DAN Annual Diving Report, 189 diver fatalities were reported in 2018 across all categories, including recreational, technical, breath-hold, commercial, public safety, and military diving operations. There were 228 diver fatalities reported in 2017. Despite the 17% decrease in fatalities from 2017 to 2018, divers are still dying and there is a lot to learn from these incidents.
Dive accidents happen, not only to reckless divers, but also to the most cautious, most well prepared, most highly trained divers in the world. While we may not want to think about it, the reality is that dive-related emergencies can happen at any time to any diver on any dive. Because of this possibility, all divers should be proactive in their efforts to mitigate the effects of chaos and confusion being added to those of shock and grief.
Whether a diver experiences a minor injury or is the unfortunate victim in a fatal accident, the need for easily accessible and reliable emergency contact information is crucial. This article dives into the importance of such precautions as well as provides specific tips for how to carry them out.
Why is Emergency Contact Information (ECI) important?
Imagine you and a buddy are on a weekend diving getaway. You could be in your home town or half-way around the world. Nevertheless, the sun is shining, the water is crystal clear, and all is well with the world. Soon after submerging, tragedy strikes, and your buddy—maybe even your best friend—never resurfaces. Suddenly, your perfect day has changed your life forever. What happens next can be handled either efficiently or chaotically, depending on the emergency contact information (ECI) on hand.
In the immediate aftermath of a tragedy, law enforcement needs to locate an emergency contact for the accident victim. If that person’s phone is locked with no known passcode, their social media accounts are private, and nothing in their wallet or on their dive gear points to any ECI for friends or family, you as the dive buddy, will need to help locate critical information. Doing this, while dealing with your own shock, adds almost unendurable stress.
Law enforcement’s primary role in any fatality investigation is to secure evidence, to identify the victim, to determine cause of death, and to make proper notifications to next-of-kin. This standard process changes in most, if not all, diving accidents that result in a death because most law enforcement agencies are either ill-equipped, untrained, or unaccustomed to handling a diving fatality.
Consequently, the more identifying information available, the easier it is for law enforcement to be effective. It should also be noted that most law enforcement agencies are not equipped to properly secure an underwater crime scene or to recover a deceased diver at depths.
ECI is a crucial piece of documentation. When a victim is seriously injured or dies, the need to contact someone in their network is necessary to initiate the next steps in the process. These steps may include providing a medical history to help EMS respond accordingly, arranging transportation home from a remote dive site, and/or notifying loved one(s).
Without ECI, an injured diver may be left on their own for hours. In cases where they are unable to advocate for themselves, medical professionals may be forced to make uninformed decisions for care. In the unfortunate case of a fatality, the lack of accessible ECI may mean that families are unaware for hours, days, or even weeks, not knowing the fate of their loved one.
Planning ahead and ensuring that ECI is available is part of “getting our affairs in order.” Divers should make available all vital information needed to assure that their loved ones will be reached in a timely manner.
Emergency Contact (Point of Contact) vs. Next-of-Kin
An emergency contact can be a close friend, a relative, a co-worker, a neighbor, a dive buddy, a mentor, a pastor, or other trusted persons in your life. Remember, naming an emergency contact is not to be taken lightly. This is the person that will be contacted in the event of an unexpected, life-changing event, and often this individual will be the one tasked with informing other people close to the accident victim.
A next-of-kin contact is the closest living relative to the injured or deceased. In some cases, this person may have legal authority to make decisions.
It is important to understand the difference between these two terms so that a diver can choose who to list as their emergency contact. News of this nature is very traumatic for all loved ones, especially significant others. Certified divers understand the inherent risks that they are taking. Even if family members who are not divers think they understand the risks, the shock of losing a loved one is devastating. It may, however, be less traumatic if that horrible news comes from someone familiar to them. For example, the diver may choose to list their best friend as their emergency contact, knowing that a friendly face can soften the tragic news. With this information available, law enforcement would notify the listed emergency contact, and that person would notify the spouse or close loved one.
In the event that there could be estate or legal implications, the decision to use next-of-kin as the emergency contact should be considered carefully.
The More Information the More Efficient
The Emergency Contact
After deciding who is to be listed, it is critical to obtain their most up-to-date contact information. At minimum, the following information should be listed and easily accessible:
- Full Name of the Person to be Contacted
- Relationship of the Person to be Contacted
- Phone Number(s) of the Person to be Contacted
In addition, it is recommended that the following information also be included:
- Email Address of the Person to be Contacted
- Full Street Address of the Person to be Contacted
The more information available, the easier it will be for medical staff or law enforcement to understand the full scope of the relationship between the injured individual and the emergency contact.
It is important to remember that a situation does not instantly resolve when an emergency contact is reached. All divers should be proactive in their approach to ensure that medical staff and law enforcement have quick and easy access to not only ECI in the event of an incident, but to personal information as well. The next section discusses ways in which to house these details but, at minimum, the following personal data should be accessible:
- Full Name
- Date of Birth
- Phone Number
- Email Address
- Full Street Address
- Primary Care Physician Contact Information
- Pertinent Medical History (i.e., Known Allergies, Recent Surgeries, etc.)
- Blood Type
Solutions for All Divers
Gathering ECI and personal information are just two steps in the process of preparing for the event of a dive accident. To be of value, these pieces of information must be easy to obtain quickly. Divers need to be aware that, for their buddies and fellow divers, being unable to contact someone close to an injured or deceased diver is the last place they want to be in the aftermath of a traumatic experience.
These following lists are not comprehensive, but represent simple solutions that all divers can start using TODAY to ensure their ECI and personal information are able to be accessed at a moment’s notice.
Emergency Contact Options
Smartphone Emergency Contact Features (Apple/Android)
Both platforms offer many features that typically include emergency access to a medical ID in the event that the owner becomes incapacitated. Although most people are unaware that this is available, in most cases, a quick internet search will give easy setup guidance.
Visible Gear Solutions
Divers love to label their gear for a number of reasons, but very few make their ECI easily accessible by adding it to their kit.
Duct Tape/Vinyl Tape
Some divers put a piece of tape on their backplate, canister light, or even cylinders that lists emergency contact information. This solution is fast, easy, and cheap.
Dog tags can be attached to a backplate or sidemount harness, or even tucked into a set of wetnotes. These typically contain ECI, as well as one or two pieces of personal information (i.e., blood type, allergies, etc.).
Smart Emergency Stickers by Dive Signs
Technology buffs will love this commercially available option. Dive Signs has created a sticker that can be placed on any non-metal surface, such as on a dive crate, on a certification card, or maybe even on a drysuit bag, and it contains a near field communication (NFC) tag. With one tap of a smartphone, anyone can have access to pre-filled emergency contact and personal information that can be easily programmed by the diver. They can be purchased here: Smart Emergency Stickers
Divers constantly need to communicate underwater. Most use hand signals, some use slates, but a common tool is wetnotes. ECI can be written on the first page for easy access after an incident.
Save-a-Dive Kit Solutions
In similar fashion to labeling dive gear, duct tape/vinyl tape can be put on the inside lid of a save-a-dive kit to list ECI. As an alternative, a printed or hand-written list (preferably laminated) can be used. It should be noted that this method likely won’t do any good if the dive buddy doesn’t know it exists and its location.
These opt-in systems are put in place for law enforcement in the event of an emergency and they are typically linked to a driver’s license. At this time, these services are only available in a few US states, with Florida having over 19 million participants.
The following form can be filled in, then printed and placed in a known location so that it is easy to access in the event of an emergency.
The most basic form of documentation, this is easy to add to a save-a-dive kit, in the console of a car, or in another secure location. This list can also be printed and laminated so that it is durable and easy to read.
Some divers may opt for advanced directives that provide instructions for medical care and only go into effect if the injured diver cannot communicate their own wishes. An emergency binder may contain additional information, including passwords, financial and insurance information, a will, and/or government documents such as a passport and social security information. If this route is taken, it is important to understand who has access to this information and when it is invoked.
The Divers Alert Network (DAN) Medical ID Tags offer divers an easy way to display important information that may help medical personnel respond quicker and more effectively in the event of a dive emergency. An ID tag displays a diver’s name, DAN ID number, date of birth, drug allergies, and an emergency contact. This information can help public safety officials make informed decisions about their care, even if they are unable to advocate for themselves.
Each individual diver will have their own method of listing an emergency contact and ensuring their personal details are comprehensive and accessible. Some divers may use suggestions from the lists above, and some divers may design their own ways of housing this important information. Regardless of the documentation method, there are three important points to remember:
List More than One (1) Emergency Contact
Life happens, and sometimes even the most reachable individual is away from their phone, so it is important to list more than one emergency contact.
Update Information when Anything Changes and Review on an Annual Basis
Information is only useful if it is kept up-to-date. Any time information changes, it should be updated on the emergency contact sheet or a personal information list. It is also good practice to review all information on an annual basis to ensure that it is accurate. An easy way to remember to review this information is at the same time as an annual cylinder visual inspection. In addition, the diver should ask their emergency contact to update them with any changes they might have.
Never List a Dive Buddy as an Emergency Contact
This one may seem obvious, but on any given day, one dive buddy has the other listed as an emergency contact. Unsurprisingly, this becomes useless if either buddy has an incident on the dive. As such, it is best practice to list someone who is never a dive buddy as an emergency contact and, again, to verify and update both your and their details.
No one expects an accident to happen to them.The fact is that even the most cautious diver may one day find themself in the middle of an incident, needing quick access to emergency information. All divers are encouraged to be proactive and to ensure that ECI and personal information are accurate and readily accessible. Making a conscious effort during all pre-dive briefs to discuss where and how to access ECI in the event of an emergency is good practice.
This article is dedicated to Ben Strelnick (NREMT, W-EMT) who died on May 26, 2023, while cave diving at Jackson Blue Spring in Marianna, Florida. He was a medic at Divers Alert Network (DAN), and was an avid diver who always put others before himself. The inspiration for this article was drawn from the lack of ECI following Ben’s death and the hardships that followed. Ben wanted nothing more than for people to dive and to do it safely, and he would without a doubt encourage others to plan ahead so that their future dive buddies, friends, and family could get through any type of tragedy with as little pain as possible.
About The Authors
Buck Buchanan and Wally Endres (NREMT, DMT) are co-owners of Dive911, LLC, a Central Florida-based dive training facility that specializes in instructor professional development and public safety pedagogy. Buck is an SDI/ERDI Instructor Trainer Evaluator and Ambassador who has 35+ years of experience in teaching, commercial diving, and heavy salvage. Wally is a Course Director, Public Safety Instructor, and former law enforcement officer who has 25+ years of experience in risk management operations and OSHA compliance consulting. Christine Tamburri (SDI Instructor) and Robert Zink (former law enforcement officer and crash reconstructionist) were also consulted in the composition and viewpoints of this article.