Michael and I have been diving for years without incurring or observing any serious accidents taking place. We follow all the rules, as we have a strong aversion to the possibility of getting a case of the bends. Even when obeying EVERY rule, however, a person may be physiologically susceptible to, or just be plain unlucky enough, to develop symptoms caused by breathing air at depth. If there is a diver who surfaces, or exits the water with complaints that lead you to believe he may have suffered a dive related incident, or if you notice someone acting strangely, be sure to incorporate The Five Minute Neuro Examination as learned in your Stress and Rescue course while awaiting the input of medical personnel. Components of the test are as follows:
- Do an orientation check. Ask the diver his/her name, the date, and to explain what happened on their dive. Answers to these questions may demonstrate the diver has some confusion. Even if answers to these questions are correct, make sure general conversation is making sense.
- Eye test- With the head held still, have the diver follow your hand while it moves in upwards/downwards, and in side to side directions. Your hand should be placed approximately 18 inches from the person's face. The eyes should track smoothly in every direction and should not exhibit any jumping/bouncing around while tracking. Look at their peripheral vision - when are they able to see an object coming around from behind their head? Is it symmetrical on both sides? Shine a flash light in their eyes. Do their pupils get smaller, then larger again when the light is removed?
- Forehead - With the divers eye's closed, lightly touch their forehead and face. Are they able to feel your touch and is it the same on both sides of the face? Check strength by trying to open the divers eyes (from above their brow) after they have shut them tightly. Ask them to furrow their brow. Is there a difference between right and left brows?
- Observe the divers face. Is the diver able to pucker his lips to whistle? Is the diver able to smile? Have them clench their jaw and have the examiner feel if both sides of the jaw are exhibiting equal strength. Is sensation present?
- Check the ears. With the divers eyes closed, ask them if their hearing seems normal. Hold your hands 2 feet from the divers ear. Rub your finger and thumb together, and gradually move closer until the diver is able to hear you.
- Check the gag reflex. Does the diver's "Adam's apple" move up and down when you ask him to swallow?
- Have the diver stick their tongue out. Make a note whether the tongue comes straight out or moves to one side or the other.
- Check the shoulder strength. With your hands firmly positioned on the divers shoulders, ask them to shrug their shoulders. Is one side stronger than the other? Do the shoulders have any sensation here?
- Check arm strength. Ask the diver to squeeze your fingers. Is one hand stronger than the other? Have them raise their arms to chest level straight in front of them. Push down gently, then pull on elbows with the diver attempting to resist the motion. Is one side stronger than the other? Are they able to feel both their arms?
- With the diver's eyes closed, check sensation their chest.
- With diver lying flat, have diver raise and lower their legs with resistance. Note if there differences in strength between sides. In standing, check balance and coordination by asking them to walk in a heel-toe fashion. Guard closely, as falls should be avoided. Is sensation in the legs present?
If the diver is unable to complete one of these tests, indicate which test was omitted and why.
Repeat the tests every hour. Make sure results are documented and present them to medical personnel.
Notice how the exam moves in a head to toe direction. The body parts are highlighted, and work their way from mind/brain to the feet. These two things may help you remember the steps of a complete exam. Hopefully this tool is one you'll never have to utilize, but as a responsible diver, you should review and practice it frequently so that if you find a diver in need, you'll be able to step up and help.