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DAN – Know Your Neuro

Photo by Stephen Frink

As the waves crashed over the reef ahead, the small dive boat anchored nearby careened at their mercy — despite being anchored in a relatively sheltered spot. No one’s ladder exits were pretty that day, but the third diver in the group, a 64-year-old man, really struggled to get back onboard. Once the divemaster and captain assisted him onto the deck and helped him out of his gear, he was breathing hard and fiercely gripping the bench on which he sat.

Article by Caitlyn Ruskell, DAN Content Writer/Editor

In an attempt to comfort the diver, the divemaster asked him if he needed some water. He clearly and coherently replied, “Yes, thanks.” When the divemaster returned with his water, the man seemed suddenly unsure why the divemaster was giving him water and when he began to try and speak he was slurring his words.

At first the divemaster was stumped by the diver’s condition so he looped in the boat captain to try and gain more insight. “Could this guy have DCS after a 30-minute dive to 25 feet? We came up so slowly …. He seems disoriented. AGE maybe?”

“Presenting with symptoms immediately after a dive doesn’t necessarily mean this guy has a diving injury. Let’s do a neuro.”

After conducting a quick neurological exam, the captain discovered that the diver was unable to lift his right arm and has persistent slurred speech. She called 911 from the boat and arranged for EMS to meet them at the dock because she suspected he might be having a stroke. She noted the time of symptom onset and made haste back toward shore.

Fifteen minutes later, the diver was transported by ambulance to the local emergency room for treatment. The attentiveness of the crew, quick action on part of the boat captain and their proximity to shore had saved this diver’s life, and all they had to do was act FAST.

Face, Arms, Speech, Time – FAST is the mnemonic you use to recall how to properly conduct a neurological exam. Check for facial droop and inability to move or raise an arm, determine slurred, mumbled or nonsensical speech, and remember to note the time at which symptoms began. If you detect any of these symptoms, call emergency medical services (EMS) immediately.

Using FAST to begin your neurological examination is an effective way to determine if a neurological injury is present — whether from a stroke, trauma or a diving injury. Quick and correct response to a neurological injury can make a life-or-death difference; the faster a victim of AGE or stroke reaches advanced medical care, the greater their likelihood of avoiding a life-altering disability or further injury.

To help divers and dive professionals recognize and respond to neurological injuries DAN developed its Neurological Assessment course. In this course, students learn how to respond to conditions that have neurological implications, such as stroke and neurological decompression sickness (DCS), by performing an effective neurological examination and rapidly activating EMS. The course, which has no prerequisites, is useful training for any lay provider and is a great addition to any first aid course.

Because every 40 seconds someone in the United States has a stroke and every three minutes and 45 seconds someone in the United States dies of a stroke, the skills learned in DAN’s Neurological Assessment course are important for all divers and nondivers. Neurological injuries do not schedule their occurrences and can happen anywhere to anyone. Staying prepared with simple skills to respond can put you in a position to save lives no matter where you are.