a) Seasickness:

• Causes: clash of information that reach the brain.
• Prevention:
  • Adopting the right behavior on the boat.
  • Take drugs only after a doctor authorization.

Your role as the SNSI Instructor is to help your students to understand the causes of sea sickness and which are the options available to relieve it to give them the opportunity to offer a enjoyable experience to their customer.

• First aid for sea sickness.

b) Dehydration:

• Causes: loss of liquids greater than liquid intake.
• Prevention: drink lots of water and fruit juice, eat fruits and vegetables.
• First aid for dehydration.

c) Hyperthermia: high body temperature due to errors in the preparatory phase:

• Wear the equipment too early compared to entering the water. Explain to your candidates that they need to coordinate their own preparation and that of the customers taking part in the excursion, if customers are ready at the same time no one will risk overheating.
• Stay under the sun for a long time. Particularly if they already worn the suit. Remind the candidates to set up shaded areas near the dressing area and always provide water for everyone to drink, in particular if the excursion is carried out in a particularly hot and sunny location.

d) Heat exhaustion:

• Cause: direct consequence of the hyperthermia.
• Signs:
  • Very high body temperature;
  • Hit and dry skin;
  • Vertigo and headache;
  • Loss of consciousness.
• Prevention:
  • Avoid body heating ( stay in the shade and avoid the wear the suit too early).
• First aid:
  • Bring the person in a cool place;
  • Hydrate the person;
  • Dip the person in cool (not cold) water or wet the skin whit cool water.

e) Sun burn:

• Cause: long exposition to the sun. Remind the candidates the water surface reflects the rays of sunshine and this favours the sun burns. 
• Signs:
  • Skin turns red and hurts.
  • If the burn is severe, swelling and sunburn blisters.
• Prevention:
  • Sunscreen.
  • Lycra suits.
  • Stay in the shade before and after the snorkeling excursion.
• First aid:
  • Creams and gels;
  • Apply cold compresses to the skin;
  • Avoid the sun, until your sunburn heals.

f) Hypothermia:

• Causes of heat loss:
  • Water temperature.
  • Type of suit used.
  • Density of the air inhaled.
• Prevention:
  • Suit adequate to water temperature.
  • Terminate the excursion in case of cold feeling.
• First aid depends on the degree of hypothermia:
  • Cold sensation.
  • Mild hypothermia.
  • Severe hypothermia.

a) Coelenterates:

• Causes: toxins injection through nematocysts.
• Prevention: avoid contact.
• First aid:
  • Wash the area with saltwater.
  • Apply antihistamine or cortisone ointment.

b) Echinoderms:

• Causes: spikes create painful injures.
• Prevention: avoid to touch.
• First aid:
  • If is possible extract the spikes and disinfect the wound.
  • If it is not possible to extract the spikes, apply vinegar.

c) Molluscs:

• Cause: they inject venom through a spine or biting (blue ringed octopus).
• Prevention: avoid contact.
• First aid: in most serious cases, CPR is needed.

d) Annelids:

• Cause: they have stinging bristles.
• Prevention: avoid contact.
• First aid and treatment: Apply antihistamine or cortisone ointment.

e) Fish:

• Cause: some fish have venomous spines.
• Prevention: avoid contact.
• First aid: immerse the area in warm water (40-50°C) and give comfort to the victim for the pain.

a) Ear barotrauma:

• Cause: lack of equalization.
• Prevention:
  • Equalize as you start descending.
  • Do not make freedives if you have a cold.
  • Do not force equalization.
  • Stop descending as soon as you feel discomfort equalizing.
• Symptoms:
  • A sensation of pressure and pain in the ear.
  • Acute pain if the eardrum is tore.
  • Sudden and violent vertigo (if the water enters due to the breaking of the ear drum).
• First aid: painkiller and seek the advice of a otorhinolaryngologist.

b) Reverse block:

• Cause: air is trapped in the middle ear.
• Prevention: do not freedive if you have a cold or if you are congested.
• Symptoms: a sensation of swelling of the ear.
• First aid: pain reliefs (after medical prescription) and seek advice of a otorhinolaryngologist.

c) Sinus barotraumas:

• Cause: obstruction of one or more ostium.
  • Flue.
  • Allergies.
  • Respiratory tract infections.
  • Excessive use of nasal decongestants.
  • Sinusitis.
  • Rhinitis.
  • Presence of polyps.
• Prevention: avoid freedives if you are congested.
• Symptoms:
  • Strong localized pain.
  • Headache.
  • Nose bleeding.
• First aid: pain reliefs (after medical prescription) and seek advice of a otorhinolaryngologist.

a) Near drowning:

• Cause: hypoxia due to diving suffocation:
  • Dry near drowning.
  • Wet near drowning.
• First aid:
  • Oxygen administration (if authorized).
  • Transfer to the closest medical centre.

b) Hyperventilation:

Used by manu athletes (aerobic sports) to reduce the amount of carbon dioxide in the blood.

It must be avoid during snorkeling and freediving because postpone the breath stimulus.

c) Hypoxia:

• Cause: condition during which the oxygen level cannot sustain the basic vital functions.
• Related pathologies.
  • Blackout: in surface or at depth (Shallow water blackout).
  • Loss of Motor Control.
• Prevention.
  • Proper breathing before each freedive.
  • Avoid hyperventilation.
• First aid.
  • Surface and at depth rescue.
  • Cardiopulmonary resuscitation.
  • Oxygen administration.

a) Causes of stress:

• Problem with equipment:
  • Suit wrong size.
  • Fins or Boots wrong size.
  • Mask wrong size (which leaks).
  • Scarce experience with the snorkel.
  • Snorkeling mouthpiece that does not fit properly.
  • Too much weight.
  • Snorkeling vest wrong size.
• Environmental factors:
  • Rough sea.
  • Strong currents.
  • Hard enter/exit point.
  • Unexpected encounters.
• Psychological factors:
  • Low level of experience.
  • Scarce knowledge of the underwater environment.
• Physical factors:
  • Alcohol consumption.
  • Drugs consumption.
  • Lack of sleep.
  • Inadequate diet before the excursion.

b) Recognize customers’ stress and anxiety:

• Sign and symptoms of stress and anxiety before the excursion:
  • Irritability.
  • Quietness, tendency to isolate from the rest of the group.
  • Mistakes when putting and managing the gear.
  • False bravery, arrogance.
• Signs and symptoms of stress during the excursion:
  • Looking for a physical contact.
  • Inefficient swimming.
  • Out of breath.
  • Problems with snorkeling gear.

a) Be ready having a plan.

a) Primary aims of rescue:

• Do not jeopardize your safety and that of other members of the group.
• Move the victim away from danger.
• Minimize physical damage caused by the accident.
• Manage the reactions of the other members of the group.

b) Assistance to a snorkeler in difficulty:

• Muscular spasm.
• Exhaustion.
• Snorkeler struggling to breath on the surface.
• Panic on the surface.

b) Blackout.

• Blackout management on surface.
• Shallow water blackout rescue.

d) Managing the group during the emergency.

WORKSHOP: present few scenarios to your class and give them a few minutes to decide how to face it. Afterwards start a group discussion.

a) Purpose:

• Quick intervention to artificially reestablish respiration in a non-breathing patient may prevent cardiac arrest.

Explain to your candidates that all the snorkeling centers and boats which provide snorkeling services should have an oxygen units available with a valve for continuous and on demand delivery. Remind the candidates to keep up to date on local laws and regulations of the places where they operate.

a) Rules of conduct:

• To know who call.
• To be able to call immediately.
• To provide all relevant information for assessing the accident and helping the victim.
• To act quickly.
• Do not go beyond the limits of your knowledge and skills at the moment.
• Take important decision following criteria to asses:
  • The condition of the victim;
  • The expected arrival time of qualified personnel;
  • Awareness of your knowledge and preparation at that particular time.

a) The ABC of cardiopulmonary resuscitation.

• (A)irways
  • Look, Listen, Feel.
• (B)reating.
• (C)irculation.

b) BLS sequences.

• Check if the victim is conscious.
• Call for help.
• Place the victim on his back and perform the “Look, Listen, Feel” step for 10 seconds.
• Call the emergency telephone number.
• Start the CPR:
  • Give 30 chest compressions;
  • Give 2 rescue breaths;
  • Continue the CPR (30:2).
• Do not stop the CPR until:
  • The EMS officers arrive;
  • The victim recover;
  • Someone can substitute you;
  • You are too exhausted to continue.

c) Defibrillator.

• ABC + D.
• Sequence:

The scheme you have learned so far remains perfectly valid (ABC) in addition the use of the defibrillator (D) must be inserted into the algorithm.

d) Oxygen.

• Equipment:
  • Tank;
  • Mask (3 types).
• Scenarios:
  • Victim who breathes properly (mask with a valve on demand).
  • Victim struggling to breathe (non-rebreather mask).
  • Unconscious person (pocket mask).

Explain to candidates that they will promptly administer oxygen in the event of a blackout and continue to administer it even after the victim’s recovery.

Organize different scenarios for the candidates and ask them to practice the techniques they have just reviewed. The candidates will play the role of victim and rescuer. Remember that after the GAS maneuver the rescuer should practice exclusively on the manikin. The rescuer should NOT ventilate the victim: the real rescue breath is performed only on the manikin, never on the volunteer, nor on any individual who breathes independently. The same thing applies to chest compression which, under no circumstances, cannot be performed on a healthy person. Chest compressions can only be performed on the manikin. However, the rescuer is allowed to identify the proper compression points, and really position the hands on the victim’s chest at these points. The rescuer can also place his shoulders above the victim’s chest as if he were about to compress.

At the end of this session students have learned:

• How to prevent issues related to environmental conditions.
• How to provide First Aid for issues related to environmental conditions.
• How to prevent injures due to potentially dangerous life forms.
• How to provide First Aid for injures due to potentially dangerous life forms.
• How to prevent Barotrauma and First aid for Barotrauma.
• How to Prevent Pathologies associated with the breathing and how to provide First Aid.
• General prevention of recue operations and review procedures for CPR First Aid and Oxygen Provider.

• The students should read Chapter 4 of the SNSI Snorkel Guide Manual and complete the Chapter 4 review questions.
• Tell the students the time, date and location of the next academic session.

• Training Record: Both you and the students must initial and date in the appropriate space in the training record section for academic session 3.