Thinking Diver

The following is a report I wrote after experiencing a minor decompression injury while diving the Alma EA Holmes Wreck off of Boston, MA.

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January 7, 2007

The Plan

My dive buddy Scott and I were diving together and our plan was to spend 30 minutes on the bottom at 160 fsw. We were breathing 21/35 in our double 130s with a rock bottom of 1000 psi. We were also carrying two aluminum 40s with 50% nitrox and 100% O2 for decompression. The plan was to descend and, per Heather’s suggestion, run a reference line across the beam of the ship so we could scooter around either side without losing track of the upline.  Heather and Dan were to meet us on the bottom shortly after we got there and the four of us were going to scooter up and down and see what we see. Time permitting, Scott wanted to run a line off into the sand near the stern to look around. I was to run the reel across the beam for the team.

The Dive

Geared up and ready to go, standing on the swim platform, I posed for a “bad-ass scootering technical diver” picture.  Two seconds later, as I was stepping off the back, my right foot slipped and I crashed ungracefully into the water, taking the scooter with me. In an effort to protect the nice ladder that was rapidly approaching my head, I put my right arm out which proceeded to slam into the swim platform on my way down. Stunned, but not in too much pain, I signaled to Dave, who was trying to assist me, that I was okay and descended to meet Scott. Scott had actually been behind me on the surface and witnessed the whole thing, and the diver I was headed to meet was really Pat. So much for team awareness. Scott came and met me, we got squared away, and descended.  My wrist and arm were sore at this point, but I didn’t think it necessary to call the dive.

We reached the bottom and visibility was very good at a dark 15-20ft.  Thanks to the low tide, the top of the wreck was at 147 fsw with the sand at around 155 fsw. Scott and I got ourselves situated and we scootered the reference line across the beam of the wreck. Having never run a line on a scooter before, this was a learning experience, but I found it surprisingly easy to let the line out. Reeling it in is another story altogether, though! From there, we scootered around in circles for a couple minutes waiting for Dan and Heather to reach the bottom. They met up with us about 10 minutes into our dive, verified the line, and we were off scootering at pitch 7 due to the decent visibility.

The four of us scootered up and down the entire length of the wreck several times. Since we crossed over the beam on more than one occasion, the reference line we had installed was a definite help. For some reason, it is easy to forget which side of the wreck you or on here and the line was very reassuring. This is definitely a technique that I’ll use in the future (thanks, Heather!).

Heather and Dan headed up the line at about 24 minutes into our dive. Scott and I decided to head for the stern one more time and look around at the pile of debris back there for our few remaining minutes of bottom time. We got back to our line at 28 minutes and I began reeling it in. I have to say, managing a scooter, a light, and a reel all at the same time was pretty task loading. In retrospect, I should’ve just let go of the scooter and thrown it ahead of me as I was reeling up the line, but at the time, I tried to keep everything in my hand at once and I had an awful time managing everything. At 31 minutes, a minute behind our planned schedule, we began our ascent. Since we had planned for 160 fsw and only saw 154 fsw briefly, we didn’t worry about our lost minute.

The Decompression

We started our deep stops at 120 fsw. In retrospect, given that the wreck barely made it past 150 fsw, this was too deep and I would prefer to have started those stops at 110 or 100 fsw. Since I knew I had injured my wrist & arm upon entry, I began lightly exercising it during the ascent in order to help prevent a DCS hit at the injury site.  Scott noticed this after our switch to 50% at 70 fsw and asked if I was alright. I signaled OK, since I was just doing preventative maintenance. Our decompression continued uneventfully aside from a bit of task loading dealing with having the scooter in my hand while trying to switch gases. We did our switch to O2 at 20 fsw and moved over to the gear line since Heather and Dan were occupying the bouncing main down line.  Once we got there, Heather started to do laps around us on her scooter, grinning ear to ear, and Scott decided to join her.  My scootering arm and wrist was still pretty sore, so I stayed put and continued to move my wrist and arm around periodically.  When Scott returned, at 60 minutes, he asked how much deco we had left and I told him 5 minutes.  At 63 minutes, we initiated a very slow ascent to the surface.

Everything was fine until I reached 15 fsw at which point I started noticing a mild, but sharp pain in my elbow and as I continued to ascend the pain got worse. I began moving my whole arm a little and gave Scott the “elbow – fucked” signal. At this point we were at 12 fsw, and he had us return to 20 fsw.  The pain went away nearly immediately with the increased depth. Since we had been on O2 for about 17 minutes at this point, I switched to back gas for a break for 4 minutes. At 73 minutes,  I switched back to O2, waited a bit, and began to ascend one more time. Again, I noticed pain in my elbow at 12 fsw, but it was much less pronounced, so I continued to surface, handed the scooter up to Dave and boarded. I exited the water at 79 minutes run time, 15 minutes past our planned run time of 64 minutes.

I got out of my gear and asked for some Aspirin and water since my elbow was still in a little pain.  Heather got it for me, asked if I thought that I had DCS, then made me stop everything and get back on the O2. I sat down on the gunnel, took the aspirin, downed some water, and started breathing my O2 again while Dan gave me a quick neuro check. I was asymptomatic except for the pain in my elbow.  Roman helped me out of my drysuit (he left the p-valve disconnection to me) and then I went inside where I got back on O2 for another 20 minutes until I had drained the tank.  By this point the pain in my elbow had gone away and did not return after stopping the O2. With some help from everyone on the boat, I got all my gear in my car and headed home.

Epilogue

For 48 hours after the incident, I had no pain or DCS symptoms at all in the elbow. My wrist and arm were x-rayed and have no broken bones from the fall, though there is obviously some internal bruising as that area is very sore. I am certain that I experienced a mild DCS hit in my elbow, most likely caused by the injury to my arm.

About 48 hrs after the incident, I began having mild pain in the elbow again. I took some ibuprofen to help with the pain and inflammation and spent a little time on O2, which did nothing to resolve the pain. As a precaution, the next day (72 hrs out) I called DAN and spoke with a Hyperbaric Doctor. He confirmed my suspicions that the pain was just a sports injury at this point and there was probably little that could be done about it except wait for it to heal. They recommended that I stay dry for three weeks, and gave me contact information for a local hyperbaric doctor at Mass General if I had further complications. I was told that procedurally we did all the right things including extending decompression, taking blood thinners and anti-inflammatories, and most importantly getting on O2 immediately after surfacing.

In retrospect, with a fall like that, I probably should have called the dive since swelling (and thus, gas trapping) was inevitable. Since the problem went away, I think that we made the right choices in doing a few (15) minutes of in-water recompression followed by hydration, aspirin, and O2 treatment on the surface. I don’t know if the light exercise of the wrist/arm underwater improved or made worse the situation.

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The pain in my elbow went away after a few days, but it was almost a year until my wrist was totally healed. On a side note, Heather and Dave (Captains of R/V Gauntlet) at Northern Atlantic Dive Expeditions took great care of me and reacted quickly to the situation.

Photographs courtesy of Northern Atlantic Dive Expeditions (c) 2007