Diving and

Subaquatic
Medicine

fifth edition

Carl Edmonds,
Michael Bennett,
John Lippmann and
Simon J. Mitchell
Diving and
Subaquatic
Medicine
fifth edition
Diving and
Subaquatic
Medicine
fifth edition

Carl Edmonds was the OIC of the Royal Australian Navy Diving Medical Unit,
Foundation President of the South Pacific Underwater Medical Society and Director
of the Australian Diving Medical Centre, Sydney, Australia
Michael Bennett is Academic Head, Wales Anaesthesia and Senior Staff Specialist,
Diving and Hyperbaric Medicine, Prince of Wales Hospital and University of New
South Wales, Sydney, Australia
John Lippmann is Founder and Chairman of Divers Alert Network Asia-Pacific,
Ashburton, Australia
Simon J. Mitchell is a Consultant Anaesthesiologist and Diving Physician, and Head,
Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Authors

Carl Edmonds, OAM, MB, BS (Sydney), MRCP Simon Mitchell, MB ChB, PhD, Dip DHM, Dip
(Lond.) FRACP, FAFOM, DPM, MRC Psych, Occ Med, Cert DHM (ANZCA), FUHM,
MANZCP, Dip DHM FANZCA
Director, Diving Medical Centre, Sydney, Head of Department, Department of
Australia (1970–2000) Anaesthesiology, University of Auckland,
Formerly, Officer in Charge Royal Australian Navy Auckland, New Zealand (2011–present)
School of Underwater Medicine (1967–1975) Consultant in Diving and Hyperbaric Medicine,
Formerly, President, South Pacific Underwater Slark Hyperbaric Unit, North Shore Hospital,
Medicine Society (1970–1975) Auckland, New Zealand (2012–present)
Consultant in Underwater Medicine to the Royal Formerly, Medical Director, Wesley Centre for
Australian Navy (1975–1991) Hyperbaric Medicine, Brisbane, Australia
Consultant in Diving Medicine (1967 until retired (1998–2002)
in 2015) Formerly, Director, Slark Hyperbaric Unit, Royal
New Zealand Navy Hospital, Auckland,
Michael Bennett, MB, BS (UNSW), DA (Lond.), New Zealand (1995–1998)
FFARCSI, FANZCA, MM (Clin Epi) (Syd.),
MD (UNSW), Dip DHM, FUHM John Lippmann, OAM, BSc, Dip Ed, MAppSc
Director, Department of Diving and Hyperbaric Founder, Chairman and Director of Research,
Medicine, Prince of Wales Hospital, Sydney, DAN (Divers Alert Network) Asia-Pacific
Australia (1993–2008) (1994–present)
Academic Head, Wales Anaesthesia, Sydney, Author or co-author of: The DAN Emergency
Australia (2012–present) Handbook, Deeper Into Diving, The Essentials
Formerly, President, South Pacific Underwater of Deeper Sport Diving, Scuba Safety in
Medicine Society (2008–2014) Australia, Oxygen First Aid, First Aid and
Formerly, Vice-President, Undersea and Hyperbaric Emergency Care, Automated External
Medical Society (2006–2007 and 2011–2012) Defibrillators, Advanced Oxygen First
Conjoint Associate Professor in Anaesthesia and Aid, Basic Life Support, Cardiopulmonary
Diving and Hyperbaric Medicine, University Resuscitation, Decompression Illness, Am I
of New South Wales, Sydney, Australia Fit to Dive? and various incarnations of these
(2010–present) books.

v
Contents

Authors v
List of abbreviations xi
Preface and excerpts from earlier editions xiii
Dedication xv
Acknowledgements xvii

Part 1 DIVING 1

1 History of diving 3
2 Physics and physiology 15
3 Free diving 27
4 Diving equipment 37
5 Undersea environments 53

Part 2 DYSBARIC DISEASES: Barotraumas 63

6 Pulmonary barotrauma 65
7 Ear barotrauma 81
8 Sinus barotrauma 103
9 Other barotraumas 115

Part 3 DECOMPRESSION SICKNESS 123

10 Decompression sickness: pathophysiology 125

11 Decompression sickness: manifestations 141
12 Decompression sickness: prevention 153
13 Decompression sickness: treatment 167
14 Dysbaric osteonecrosis 185

Part 4 ABNORMAL GAS PRESSURES 203

15 Inert gas narcosis 205

16 Hypoxia 217
17 Oxygen toxicity 229

vii
viii Contents

18 Carbon dioxide toxicity 245

19 Breathing gas preparation and contamination 255
20 High-pressure neurological syndrome 267

Part 5 AQUATIC DISORDERS: The drowning syndromes 273

21 Drowning 275
22 Pathophysiological and clinical features of drowning 285
23 The management of drowning 291
24 Salt water aspiration syndrome 303
25 Why divers drown 309

Part 6 OTHER AQUATIC DISORDERS 319

26 Seasickness (motion sickness) 321

27 Thermal problems and solutions 325
28 Cold and hypothermia 329
29 Infections 339
30 Scuba divers’ pulmonary oedema 357
31 Trauma from marine creatures 367
32 Venomous marine animals 377
33 Fish poisoning 397
34 Underwater explosions 405

Part 7 SPECIFIC DIVING DISEASES 411

35 The ear and diving: anatomy and physiology 413

36 The ear and diving: investigations 421
37 The ear and diving: hearing loss 429
38 The ear and diving: vertigo and disorientation 435
39 Cardiac problems and sudden death 449
40 Neurological disorders of diving 459
41 Psychological and neuropsychological disorders 467
42 Miscellaneous disorders 487
Carotid sinus syndrome 487
Caustic cocktail 488
Cold urticaria 488
Dental disorders 488
Hyperthermia 489
Musculoskeletal problems 489
Compression (hyperbaric) arthralgia 489
Cramp 489
Decompression 490
Lumbosacral lesions 490
Temporo-mandibular joint dysfunction 490
Tank carrier’s elbow 491
Ocular disorders 492
‘Bubble eyes’ 492
 Contents ix

Ocular problems from corneal lenses 492

Ocular fundus lesions 492
‘Swimmer’s eyes’ (blurred vision) 493
Trauma 493
Other disorders 493
Pulmonary oedema and dyspnoea 493
Diving diseases 493
Asthma provocation 493
Cold urticaria 494
Deep diving dyspnoea 494
Skin reactions to equipment 494
Contact dermatitis (mask, mouthpiece and fin burn) 494
Angioneurotic oedema (dermatographia) 494
Allergic reactions 495
Burns 495
Diaper Rash (nappy rash) 495
Fin ulcers 495
Trauma 495
43 Drugs and diving 497
44 Long-term effects of diving 509

Part 8 THE DIVING ACCIDENT 517

45 Stress responses, panic and fatigue 519

46 Why divers die: the facts and figures 527
47 Unconsciousness 551
48 First aid and emergency treatment 557
49 Oxygen therapy 567
50 Investigation of diving accidents 575
51 Investigation of diving fatalities 583

Part 9 MEDICAL STANDARDS FOR DIVING 601

52 Medical standards for snorkel divers 603

53 Medical standards for recreational divers 607
54 Medical standards for commercial divers 623
55 Asthma 629
56 Cardiac and peripheral vascular disease 649
57 Insulin-dependent diabetes mellitus 657
58 Age and diving 673
59 Diver selection 681

Part 10 SPECIALIZED DIVING AND ITS PROBLEMS 685

60 Female divers 687

61 Breath-hold diving 697
62 Technical diving 703
63 Divers with disabilities 719
x Contents

64 Submarine medicine 725

65 Occupational groups 731
66 Diving in contaminated water 737
67 Deep and saturation diving 739

Part 11 RELATED SUBJECTS 745

68 Hyperbaric equipment 747

69 Hyperbaric medicine 755

Appendix A: Decompression tables 767

Appendix B: US Navy recompression therapy tables 785

Appendix C: Recompression therapy options 793

Appendix D: Diving medical library 797

Appendix E: Diving medical training 801

Appendix F: Diving medical organizations and contacts 803

List of abbreviations

ADS atmospheric diving suit FEV1 forced expiratory volume in 1 second

ADV automatic diluent valve FIO2 fraction of inspired oxygen
AGE arterial gas embolism FVC forced vital capacity
ALS advanced life support HBOT hyperbaric oxygen therapy
ARDS acute respiratory distress syndrome HPNA high-pressure neurological syndrome
ATA atmosphere absolute IBCD isobaric counterdiffusion
ATG atmosphere gauge ICP intracranial pressure
BCD buoyancy compensator device IDDM insulin-dependent diabetes mellitus
BLS basic life support ILCOR International Liaison Committee on
BOV bail-out valve Resuscitation
BSAC British Sub-Aqua Club IPE immersion pulmonary oedema
CAD coronary artery disease IPPV intermittent positive pressure
CAGE cerebral arterial gas embolism ventilation
CCR closed-circuit rebreather ISO International Organization for
CMF constant mass flow Standardization
CPAP continuous positive airway pressure lpm litres per minute
CPR cardiopulmonary resuscitation MOD maximum operating depth
CSF cerebrospinal fluid msw metres of sea water
CSL Commonwealth Serum Laboratories NEDU Navy Experimental Diving Unit
DAN Divers Alert Network NOAA National Oceanic and Atmospheric
dB decibel Administration
DCI decompression illness NUADC National Underwater Accident Data
DCIEM (Canadian) Defence and Civil Centre
Institute of Environmental Medicine OPV over-pressure valve
DCS decompression sickness PaCO2 alveolar pressure of carbon dioxide
DDC deck decompression chamber PaCO2 arterial pressure of carbon dioxide
DPV diver propulsion vehicle PADI Professional Association of Diving
EAD equivalent air depth Instructors
ECC external cardiac compression PaO2 alveolar partial pressure of oxygen
ECG electrocardiogram PaO2 arterial partial pressure of oxygen
ECMO extracorporeal membrane oxygenation PCO2 partial pressure of carbon dioxide
ECoG electrocochleography PEEP positive end-expiratory pressure
EEG electroencephalogram PEF peak expiratory flow
ENG electronystagmography PFO patent foramen ovale
EPIRB electronic position-indicating radio PICO2 inspired partial pressure of carbon
beacon dioxide

xi
xii List of abbreviations

PIO2 inspired partial pressure of oxygen SDPE scuba divers’ pulmonary oedema
PMCT post-mortem computed tomography SMB surface marker buoy
PMDA post-mortem decompression artefact SPUM South Pacific Underwater Medicine
PMV pressure maintaining valve Society
PN2 partial pressure of nitrogen SSBA surface-supply breathing apparatus
PO2 partial pressure of oxygen SWAS salt water aspiration syndrome
PPV positive pressure ventilation UHMS Undersea and Hyperbaric Medical
RAN Royal Australian Navy Society
RCC recompression chamber UPTD unit of pulmonary toxic dose
RGBM reduced gradient bubble model USN United States Navy
RMV residual minute volume (also VC vital capacity
respiratory minute volume) VER visual evoked response
SCR semi-closed-circuit rebreather VGE venous gas emboli
scuba self-contained underwater breathing VPM varying permeability model
apparatus V/Q ventilation-perfusion
Preface and excerpts from
earlier editions

This book is written for doctors and paramedics a comprehensive clinical text. We tried to remedy
who are called on to minister to the medical needs this. Our primary focus remains on the diving cli-
of those divers who venture on or under the sea. nician, the physician responsible for scuba divers,
It was based on our experience in dealing with a the diving paramedic and the exceptional diving
vast number of diving accidents and with trouble- instructor who needs some guidance from a prac-
shooting many diving problems, and it is also an tical reference text.
attempt to integrate the experience and more eru- Diving accidents are much better defined,
dite research of others. investigated and treated than when we com-
The very generous praise bestowed by review- menced writing on this subject, many years ago.
ers on the first edition of Diving and Subaquatic It was our intent to present, as completely as
Medicine, and its surprising acceptance outside the ­possible, an advanced and informative book on
Australasian region, inspired us to prepare further clinical diving medicine. We have avoided the
editions of this text. ­temptation to write either a simplistic text or a
In the later editions, we attempted to be less research-­oriented tome.
insular. Instead of an Australian book about This text encompasses the range of diving dis-
Australian experiences, we sought the advice and orders experienced by divers. It presents all aspects
guidance of respected friends and colleagues from of diving medicine from ancient history to the
other countries, and from other disciplines, espe- latest trends, in a concise and informative man-
cially in the United Kingdom, the United States, ner. Each disorder is dealt with from a historical,
Canada, Japan and mainland Europe. This has not aetiological, clinical, pathological, preventive and
prevented us from being judgemental and selective ­t herapeutic perspective. Summaries, case histories
when we deemed it fit. This is still a very special- and revision aids are interspersed throughout. For
ized field where evidence-based medicine is in its the doctor who is not familiar with the world of
infancy. Truth is not always achieved by voting, diving, introductory chapters on physics and phys-
and consensus is often a transitory state. We have iology, equipment and the diving environments
documented what we believe to be current best have been included.
practice. The future will judge this. The inclusion of anecdotes and occasional
The extension of diving as a recreational and humour may lessen the load on the reader, as
commercial activity has led to the bewildered it does on the authors. As in previous editions,
medical practitioner’s being confronted with div- each chapter is edited by one of the authors, with
ing problems about which he or she has received overview and peer review available from the oth-
little or no formal training. Doctors interested in ers. This means that not always will there be exact
diving had previously found themselves without agreement among authors, and there may be some

xiii
xiv Preface and excerpts from earlier editions

variation among chapters. This is inevitable when will experience as much excitement, fascination,
evidence and consensus are not always complete. achievement, ­camaraderie and fun from diving as
It is also healthy for the future. we have.
Three of the four previous authors have
departed from this scene, and the fourth is about Carl Edmonds, 2015
to leave. The baton needs to be passed. Our leg- on behalf of all previous
acy and intent are that our younger colleagues and new authors of this text.
Dedication

This book is dedicated to the memory of Pluto, who study when the original three authors were postu-
died, even though he never left dry land. lating about an appropriate dedicatee for their text.
I have often been asked who Pluto was. He was We could not decide between Paul Bert, Al Behnke,
a much loved basset hound who strolled into our Jr., and J.B.S. Haldane. Pluto solved our dilemma.

xv
Acknowledgements

Carl Edmonds, John Lippmann, Michael Bennett Peter Bennett Eric Kindwall
and Simon Mitchell would like to thank Chris­ Ralph Brauer Clarrie Lawler
topher Lowry, John Pennefather and Robyn Walker Greg Briggs Christopher Lawrence
for their invaluable contributions to previous edi- Ian Calder Dale Mole
tions, upon which material in this latest fifth edition Jim Caruso Owen O’Neill
is based. Richard Chole John Pearn
We wish to acknowledge the assistance given David Dennison Peter Sullivan
by the Royal Australian Navy, the Royal Navy and Chris Edge Ed Thalmann
the United States Navy for permission to repro- Glen Egstrom John Tonkin
duce excerpts from their diving manuals, and to David Elliott John Williamson
the many pioneers on whose work we have so heav- Des Gorman David Yount
ily drawn, our families who have suffered unfairly, John Hayman
and our clinical tutors – the divers.
Numerous experts have been consulted to Originally published in 1976 by the Diving Medical
review and advise on specific chapters of this or Centre (Australia) ISBN 09597191-0-5.
previous editions. Our gratitude is extended to
these valued colleagues, but they are not to blame
for the final text. They include the following:

xvii
 1
Part    

Diving

1 History of diving 3
2 Physics and physiology 15
3 Free diving 27
4 Diving equipment 37
5 Undersea environments 53
 1
History of diving

Breath-hold diving 3 Modern military diving 8

Early equipment 4 Deep diving 9
Modern diving equipment 6 Recreational diving 12
Self-contained equipment 7 Further reading 12

BREATH-HOLD DIVING In other parts of the world, industries involving

breath-hold diving persist, to some extent, to this
The origins of breath-hold diving are lost in time. Notable examples include the Ama, or diving
time. Archaeologists claim that the Neanderthal women of Japan and Korea, and the pearl divers of
human, an extinct primitive human, dived for the Tuamoto Archipelago.
food, likely in the first instance gathering shell- The Ama has existed as a group for more than
fish by wading at low tide before diving from 2000 years. Originally the male divers were fisher-
canoes. By 4500 BC, underwater exploration had men, and the women collected shells and plants.
advanced from the first timid dive to an indus- The shells and seaweed are a prized part of Korean
try that supplied the community with shells, food and Japanese cuisine. In more recent times, diving
and pearls. has been restricted to the women, with the men
From the ancient Greek civilization until today, serving as tenders. Some attribute the change in
fishers have dived for sponges, which, in earlier pattern to better endurance of the women in cold
days, were used by soldiers as water canteens and water. Others pay homage to the folklore that div-
wound dressings, as well as for washing. ing reduces the virility of men, a point many divers
Breath-hold diving for sponges continued seem keen to disprove.
until the nineteenth century when helmet diving There is a long history of the use of divers
equipment was introduced, allowing the intrepid for strategic purposes. Divers were involved in
to gamble their lives in order to reach the deeper operations during the Trojan Wars from 1194
sponge beds. Greek divers still search the waters to 1184 BC. They sabotaged enemy ships by bor-
of the Mediterranean Sea as far afield as northern ing holes in the hull or cutting the anchor ropes.
Africa for sponges. Divers were also used to construct underwater
The ancient Greeks laid down the first rules defences designed to protect ports from the attack-
on the legal rights of divers in relation to salvaged ing fleets. The attackers in their turn used divers to
goods. The diver’s share of the cargo was increased remove the obstructions.
with depth. Many divers would prefer this arrange- By Roman times, precautions were being taken
ment to that offered by modern ­governments and against divers. Anchor cables were made of iron
diving companies. chain to make them difficult to cut, and special

3
4 History of diving

guards with diving experience were used to protect not permitted to pull on this line to assist movement.
the fleet against underwater attackers. No weights can be removed during the dive. Mono-
An interesting early report indicated that some fins or bi-fins can be used.
Roman divers were also involved in Mark Anthony’s ‘Constant weight without fins’ is the same as
attempt to capture the heart of Cleopatra. Mark constant weight apnoea but without the use of fins.
Antony participated in a fishing contest held in With ‘variable weights’, the diver again descends
Cleopatra’s presence and attempted to improve his with the aid of a weighted sled, but this weight is
standing by having his divers ensure a constant sup- limited. Ascent is achieved by finning or pulling up
ply of fish on his line. The Queen showed her dis- the cable, or both.
pleasure by having one of her divers fasten a salted ‘Free immersion’, which emerged in places
fish to his hook. where equipment was difficult to obtain, involves
Marco Polo and other travellers to India and a finless diver (with optional suit, mask or weights)
Sri Lanka observed pearl diving on the Coromandel who pulls himself or herself down and then up a
Coast. They reported that the most diving was to weighted line.
depths of 10 to 15 metres, but that the divers could ‘Static apnoea’ involves resting breath-holding
reach 27 metres by using a weight on a rope to assist (usually lying in a pool) with the face submerged.
descent. They carried a net to put the oysters in Officially recorded times in excess of 11 minutes
and, when they wished to surface, were assisted by have been achieved using this method.
an attendant who hauled on a rope attached to the ‘Dynamic apnoea’ measures the distance cov-
net. The divers were noted to hold their nose during ered in a pool during a single breath-hold.
descent.
The most skilled of the American native div- EARLY EQUIPMENT
ers came from Margarita Island. Travellers who
observed them during the sixteenth, seventeenth The history of diving with equipment is long and
and eighteenth centuries reported that these divers complex, and in the early stages it is mixed with
could descend to 30 metres and remain submerged legend. The exploits of Jonah are described with
for 15 minutes. They could dive from sunrise to conviction in one text, but there is a shortage of
sunset, 7 days a week and attributed their endur- supporting evidence. Further reference is made to
ance to tobacco! They also claimed to possess a him later, on the technicality that he was more a
secret chemical that they rubbed over their bod- submariner than a diver. Because his descent was
ies to repel sharks. The Spaniards exploited these involuntary, Jonah was at best a reluctant pioneer
native divers for pearling, salvage and smuggling diver. The history of submarine escape, when the
goods past customs. The demand for divers was submariner may become a diver, is discussed in
indicated by their value on the slave market, fetch- Chapter 64.
ing prices up to 150 gold pieces. Some claim that Alexander the Great descended
Free diving appears to have evolved as a modern in a diving bell during the third century BC.
sport in the mid-1940s, initially as a competition Details of the event are vague, and some of the fish
among Italian spearfishers. Currently the sport, stories attributed to him were spectacular. One fish
which is steadily gaining popularity, encompasses was said to have taken 3 days to swim past him! It
a variety of disciplines. These include the following: is most unlikely that the artisans of the time could
In ‘no limits’, a diver can use any means to travel make glass as depicted in most of the illustra-
down and up the line, as long as the line is used to tions of the ‘event’. This may have been a product
measure the distance. Most divers descend down a of artistic licence or evidence that the incident is
line using a weighted sled and return to the surface based more in fable than in fact.
aided by an inflatable balloon. Officially recorded Snorkels, breathing tubes made from reeds and
depths in excess of 210 metres have been achieved bamboo (now plastic, rubber or silicone), were
using this method. developed in many parts of the world. They allow a
‘Constant weight apnoea’ diving is where descent diver to breathe with the head underwater. Aristotle
and ascent occur along a line, although the diver is inferred that the Greeks used them. Columbus
 Early equipment 5

reported that the North American Indians would with air in barrels (Figure 1.1). With this devel­
swim toward wild fowl while breathing through opment diving bells became more widespread.
a reed and keeping their bodies submerged. They They were used for salvage, treasure recovery and
were able to capture the birds with nets, spears or general construction work. Halley’s bell was sup-
even their bare hands. The Australian aborigines plied with air from weighted barrels, which were
used a similar approach to hunt wild duck. Various hauled from the surface. Dives to 20 metres for up
people have ‘invented’ long hose snorkels. The one to 1 1/2 hours were recorded. Halley also devised
designed by Vegetius, dated 1511, blocked the ­diver’s a method of supplying air to a diver from a hose
vision and imposed impossible loads on the breath- connected to the bell. The length of hose restricted
ing muscles. the diver to the area close to the bell. It is not
Some have interpreted an Assyrian drawing known whether this was successful. Halley was
dated 900 BC as an early diving set. The drawing one of the earliest recorded sufferers of middle ear
shows a man with a tube in his mouth. The tube barotrauma.
is connected to some sort of bladder or bag. It is Swedish divers had devised a small bell, occu-
more likely a float or life jacket. The tube length pied by one person and with no air supply to
was a metre or more and so impossible to breathe it. Between 1659 and 1665, 50 bronze cannons,
through. each weighing more than 1000 kg, were salvaged
Leonardo da Vinci sketched diving sets and fins. from the Vasa. This Swedish warship had sunk
One set was really a snorkel that had the disadvan- in 30 metres of water in Stockholm harbour.
tage of a large dead space. Another of his ideas
was for the diver to have a ‘wine skin to contain
the breath’. This was probably the first recorded
design of a self-contained breathing apparatus. His
drawings appear tentative, so it is probably safe to
assume that there was no practical diving equip-
ment in Europe at that time.
Another Italian, Borelli, in 1680, realized that
Leonardo was in error and that the diver’s air
would have to be purified before he breathed it
again. Borelli suggested that the air could be puri-
fied and breathed again by passing it through a
copper tube cooled by sea water. With this concept,
he had the basic idea of a rebreathing set. It could
also be claimed that he had the basis of the experi-
mental cryogenic diving set in which gas is carried
in liquid form and purified by freezing out carbon
dioxide.
Diving bells were the first successful method
of increasing endurance underwater, apart from
snorkels. These consist of a weighted chamber,
open at the bottom, in which one or more people
could be lowered under water. The early use of
bells was limited to short periods in shallow water.
Later, a method of supplying fresh air was devel-
oped. The first fully documented use of diving bells
dates from the sixteenth century.
In 1691, Edmond Halley, the English astrono- Figure 1.1 Edmond Halley’s diving bell, 1691. The
mer who predicted the orbit of the comet that bears weighted barrels of air that were used to replen-
his name, patented a diving bell that was supplied ish the air can be clearly seen.
6 History of diving

The guns were recovered by divers working from

a bell, assisted by ropes from the surface. This task
would not be easy for divers, even with the best of
modern equipment.

MODERN DIVING EQUIPMENT

The first people to be exposed to a pressure change
in a vessel on the surface were patients exposed
to higher or lower pressure as a therapy for vari-
ous conditions – the start of hyperbaric medicine.
The origins of diving medical research can also be
traced to these experiments.
During the second half of the nineteenth cen-
tury, reliable air pumps were developed. These
were able to supply air against the pressures
experienced by divers. Several people had the
idea of using these pumps for diving and devel-
oped what are now called open helmets, which
cover the head and shoulders. Air was pumped
down to the diver, and the excess air escaped Figure 1.2 Augustus Siebe’s first helmet.
from the bottom of the helmet. The diver could
breathe because the head and neck were in air, or the same time, with borrowing and stealing of
at least they were until the diver bent over or fell. ideas from each other.
If this happened, or if the hose or pump leaked, By the mid-nineteenth century, several types
the helmet flooded and the diver was likely to of diving suits and a bell were used by the Royal
drown. The Deane brothers were the inventors Engineers on dives on the wreck of the Royal George,
and among the major users of this equipment, which obstructed the anchorage at Spithead. The
and John Deane continued to use it up to the Siebe suit was found to be greatly superior to the
time of the Crimean War. other designs. Siebe’s apparatus allowed the diver
Standard rig, or standard diving dress, was to bend over or even lie down without the risk of
first produced in 1840 by Augustus Siebe (a Russian flooding the helmet. Also, the diver could control his
immigrant engineer who later became a natural- depth easily. A diver in an open helmet had to climb
ized British citizen). This equipment consisted of a ladder or rely on his tenders to do this.
a rigid helmet sealed to a flexible waterproof suit In more modern versions, the helmet is fitted
(Figure 1.2). Air was pumped down from the sur- with communications to allow the diver to confer
face into the helmet, and excess air bled off through with another diver or the surface. One of the devel-
an outlet valve. The diver could control buoyancy opments from the Siebe closed helmet was the US
by adjusting the flow through the outlet valve and Navy Mark 5 helmet. It probably set a record by
thus the volume of air in the suit. This type of being in service for 75 years.
equipment, with a few refinements, is still in use. The Royal Engineers were taught to dive by
Siebe’s firm came to be the major manufac- civilian divers in 1939–40 while on the Royal
turer, but his role in the design may have been George. They then established a training facility
overstated, possibly for the marketing advan- at Gillingham in 1844 where they reintroduced
tages gained by his firm, which marketed the first ­diving to the Royal Navy, which set up their first
acceptable equipment of this type. The origins diving school on HMS Excellent later that year.
and evolution from open helmet and standard Decompression sickness was noted, albeit not
dress were the subject of a study by Bevan, who recognized in divers, following the development
discussed several designs that were developed at of these diving suits. Divers were given fresh dry
 Self-contained equipment 7

undergarments because the ‘rheumatic’ pains they Haldane also developed ­several improvements to the
suffered were attributed to damp and cold. Other diving equipment used.
divers suffered paralysis that was attributed to In 1914, US Navy divers reached 84 metres.
fatigue from zeal and overexertion. Most of these The next year they raised a submarine near Hawaii
men would have been suffering from decompres- from a depth of 93 metres. This was a remarkable
sion sickness because they were diving for up to feat considering that the salvage techniques had to
three times the accepted limits for dives without be evolved by trial and error. The divers used air, so
decompression stops. they were exposed to a dangerous degree of nitro-
Decompression sickness was also observed in gen narcosis, as well as decompression sickness.
workers employed in pressurized caissons and
tunnels. In these operations, the working area is SELF-CONTAINED EQUIPMENT
pressurized to keep the water out. The history of
decompression sickness is discussed in Chapter 10. Self-contained underwater breathing appara-
Paul Bert and J. S. Haldane are the fathers of tus (scuba) is used to describe any diving set that
diving medicine. Paul Bert published a text book allows the diver to carry the breathing gas sup-
La pression barométrique based on his studies of ply with him or her. There are several claims to its
the physiological effect of changes in pressure. His invention, based on old drawings. The first work-
book is still used as a reference text even though able form probably dates from the early nineteenth
it was first published in 1878. Bert showed that century. There is a brief report of an American
decompression sickness was caused by the forma- engineer, Charles Condert, who made a scuba in
tion of gas bubbles in the body and suggested that which the compressed air was stored in a copper
it could be prevented by gradual ascent. He also pipe worn around his body. The gas was released
showed that pain could be relieved by a return to into a hood that covered the upper half of his body.
higher pressures. Such cases were initially man- Accumulation of carbon dioxide was controlled by
aged by the diver’s returning to the pressure of the allowing the respired gas to escape through a small
caisson. However, specially designed recompres- hole. It was then replaced by fresh gas from the
sion chambers were introduced and utilized at storage pipe. Condert died while diving with his
some job sites within a few years. equipment in the East River in New York in 1831.
J.S. Haldane, a Scottish scientist, was appointed In 1838, Dr Manuel Guillaumet filed a patent
to a Royal Navy committee to investigate the prob- in France for a back-mounted, twin-hose demand
lem of decompression sickness in divers. At that regulator that was supplied with air from hoses
time the Royal Navy had a diving depth limit of to the surface. A patent for a similar device was
30 metres, but deeper dives had been recorded. also filed in England earlier that year by William
Greek and Swedish divers had reached 58 metres Newton, but it seems likely that this was done on
in 1904, and Alexander Lambert had recovered behalf of Guillaumet.
gold bullion from a wreck in 50 metres of water in Another early development was the Rouquayrol
1885, but he had developed partial paralysis from and Denayrouze device of 1865 (Figure 1.3). This
decompression sickness. set was supplied with air from the surface that was
Haldane concluded from Paul Bert’s results that breathed on demand via a mouthpiece. It was fitted
a diver could be hauled safely to the surface from with a compressed air reservoir so that the diver
10 metres with no evidence of decompression sick- could detach himself or herself from the air hose
ness. He deduced from this that a diver could be sur- for a few minutes. The endurance, as a scuba, was
faced from greater than 10 metres in stages, provided limited by the amount of air in the reservoir.
that time was spent at each stage to allow absorbed The first successful scuba with an air supply
nitrogen to pass out of the body in a controlled man- appears to have been developed and patented in
ner. This theory was tested on goats and then on men 1918 by Ohgushi, who was Japanese. His system
in chambers. Haldane’s work culminated in an open could be operated with a supply of air from the
water dive to 64 metres in 1906 and the publication surface or as a scuba with an air supply cylinder
of the first acceptable set of decompression tables. carried on the back. The diver controlled the air
8 History of diving

These sets are often called scuba, but they may be

considered separately because of the difference in
principles involved. The patent for the first known
prototype of an oxygen rebreather was given to
Pierre Sicard, who was French, in 1849. The first
known successful rebreathing set was designed by
English engineer H. A. Fleuss in 1878. This was an
oxygen set in which carbon dioxide was absorbed
by rope soaked in caustic potash.
Because of the absence of lines and hoses from
the diver to the surface, the set was used in flooded
mines and tunnels where the extra mobility, com-
pared with the standard rig, was needed. Great
risks were taken with this set and its successors
when used underwater because the work of Paul
Bert on oxygen toxicity was not widely known.
This equipment was the precursor of oxygen sets
used in clandestine operations in both world wars
and of other sets used in submarine escape, fire-
fighting and mine rescue.

MODERN MILITARY DIVING

The military use of divers in warfare was, until 1918,
largely restricted to the salvage of damaged ships,
clearing of channels blocked by wrecks, and assorted
ships’ husbandry duties. One significant clandestine
operation conducted during the First World War
was the recovery of code books and minefield charts
from a sunken German submarine. This was of more
Figure 1.3 The aerophore, devised by significance as an intelligence operation, although
Rouquayrol and Denayrouze, 1865. This device the diving activity was also kept secret.
was widely used and was an important milestone During the First World War, Italy developed a
in the development of the modern scuba. human torpedo or chariot that was used in 1918
to attack an Austrian battleship in Pola Harbour
supply by triggering air flow into the mask with in what is now Croatia. The attack was a success
the diver’s teeth. Another scuba was devised by in that the ship was sunk, but, unfortunately, it
Le Prieur in 1933. In this set, the diver carried a coincided with the fall of the Austro-Hungarian
compressed air bottle on the chest and released air Empire, and the ship was already in friendly
into the face mask by opening a tap. hands! The potential of this method of attack was
In 1943, Cousteau and Gagnan developed the noted by the Italian Navy. They put it to use in the
first popular scuba as we know it today. It was an Second World War with divers wearing oxygen
adaptation of a reducing valve that Gagnan had rebreathing sets as underwater pilots. In passing,
evaluated for use in gas-powered cars and was far it is interesting to note that the idea of the chariot
smaller than the Rouquayrol-Denayrouze device. was suggested to the British Admiralty in 1909,
Closed-circuit oxygen sets were developed dur- and Davis took out patents on a small submarine
ing the same period as the modern scuba. In these and human torpedo controlled by divers in 1914.
rebreathing sets, the diver is supplied with oxygen This was pre-dated by a one-person submarine
and the carbon dioxide is removed by absorbent. designed by J.P. Holland in 1875.
 Deep diving 9

Diving played a greater part in offensive opera- idea proposed by Sir Leonard Hill and developed
tions during the Second World War. Exploits of by Siebe Gorman and Co. Ltd. The advantage of this
note include those of the Italian Navy. They used equipment is that, by increasing the ratio of oxygen
divers riding modified torpedoes to attack ships in to nitrogen in the breathing gas, one can reduce or
Gibraltar and Alexandria. After a series of unsuc- eliminate decompression requirements. It is nor-
cessful attempts with loss of life, they succeeded in mally used with equipment in which most of the gas
sinking several ships in Gibraltar harbour in mid- is breathed again after the carbon d­ ioxide has been
1941. Later that year, three teams managed to enter removed. This allows reduction of the total gas vol-
Alexandria harbour and damage two battleships ume required by the diver.
and a tanker. Even Sir Winston Churchill, who During the Second World War, this idea was
did not often praise his enemies, said they showed adapted to a self-contained semi-closed rebreath-
‘extraordinary courage and ingenuity’. Churchill ing apparatus that was first used extensively by
had previously been responsible for rejecting sug- divers clearing mines. This development was
gestions that the Royal Navy use similar weapons. ­conducted by the British Admiralty Experimental
In Gibraltar, a special type of underwater war Diving Unit in conjunction with Siebe Gorman
evolved. The Italians had a secret base in neutral and Co. Ltd. The change to a self-contained set was
Spain, only 10 kilometres away, and launched several needed to reduce the number of people at risk from
attacks that were opposed by British divers who tried accidental explosions in mine-clearing operations.
to remove the Italian mines before they exploded. The reduction, or elimination, of decompression
Divers from the allied nations made s­everal time was desirable in increasing the diver’s chances
successful attacks on enemy ships, but their most of survival if something went wrong. The equip-
important offensive roles were in the field of recon- ment was constructed from non-magnetic materi-
naissance and beach clearance. In most operations, als to reduce the likelihood of activating magnetic
the divers worked from submarines or small boats. mines and was silent during operation for work on
They first surveyed the approaches to several poten- acoustically triggered mines.
tial landing sites. After a choice had been made,
they cleared the obstructions that could impede the DEEP DIVING
landing craft. One of the more famous exploits of an
American diving group was to land unofficially and The search for means to allow humans to descend
leave a ‘Welcome’ sign on the beach to greet the US deeper has been a continuing process. By the early
Marines, spearheading the invasion of Guam. The twentieth century, deep diving research had enabled
British Clearance Divers and the US Navy Sea, Air, divers to reach depths in excess of 90 metres; at
Land Teams (SEALs) evolved from these groups. The which depth the narcosis induced by nitrogen inca-
Clearance Divers get their name from their work in pacitated most humans.
clearing mines and other obstructions, a role they After the First World War, the Royal Navy d­ iving
repeated during and after the Gulf War. research tried to extend its depth capability beyond
The research back-up to these exploits was largely 60 metres. Equipment was improved, the submers-
devoted to improvement of equipment and the ible decompression chamber was introduced and
investigation of the nature and onset of oxygen tox- new decompression schedules were developed that
icity (Chapter 17). This work was important because used periods of oxygen breathing to reduce decom-
most of these offensive operations were conducted pression time. Dives were made to 107 metres, but
by divers wearing oxygen breathing apparatus. The nitrogen narcosis at these depths made such dives
subjects were the unsung heroes of the work. This both unrewarding and dangerous.
group of scientists, sailors and conscientious objec- Helium diving resulted from a series of
tors deliberately and repeatedly suffered oxygen American developments. In 1919, a scientist,
­toxicity in attempts to understand the condition. Professor Elihu Thompson, suggested that nitro-
Oxygen-nitrogen mixtures were first used for gen narcosis could be avoided by replacing the
diving by the Royal Navy in conjunction with a nitrogen in the diver’s gas supply with helium.
standard diving rig. This approach was based on an At that stage, the idea was not practical because
10 History of diving

helium cost more than US $2000 per cubic foot.

Later, following the ­exploitation of natural gas
supplies that contained helium, the price dropped
to about 3 cents per cubic foot.
Research into the use of helium was conducted
during the 1920s and 1930s. By the end of the 1930s,
divers in a compression chamber had reached a
­pressure equal to a depth of 150 metres, and a dive
to 128 metres was made in Lake Michigan. Between
the two world wars, the United States had a vir-
tual monopoly on the supply of helium and thus
­dominated research into deep diving.
For hydrogen diving, the use of hydrogen in
gas mixtures for deep diving was first tried by Arne
Zetterstrom, a Swedish engineer. He demonstrated
that hypoxia and risks of explosion could be avoided
if the diver used air from the surface to 30 metres,
changed to 4 per cent oxygen in nitrogen and then
changed to 4 per cent or less oxygen in hydro-
gen. In this manner, the diver received adequate
­oxygen, and the formation of an explosive mixture
of oxygen and hydrogen was prevented.
In 1945, Zetterstrom dived to 160 metres in
Figure 1.4 Prof Bühlmann (rear) and Hannes
open water. Unfortunately, an error was made Keller prepare for the first simulated dive to
by the operators controlling his ascent, and they 3000 m (1000 ft) on 25 April 1961.
hauled him up too fast, omitting his planned gas
transition and decompression stops. He died of
hypoxia and decompression sickness shortly after encouraged the development of more sophisti-
reaching the surface. cated mixed gas sets. The most complex of these
Hydrogen has been used successfully both for have separate cylinders of oxygen and diluting
decreasing the density of the breathing gas mixture gas. The composition of the diver’s inspired gas
and ameliorating the signs and symptoms of high- is maintained by the action of electronic control
pressure neurological syndrome. The cheapness of systems that regulate the release of gas from each
hydrogen compared with helium, and the probabil- cylinder. The first of these sets was developed in
ity of a helium shortage in the future, may mean that the 1950s, but they have been continually refined
hydrogen will be more widely used in deep dives. and improved.
Other European workers followed Zetterstrom Modern air or gas mixture helmets have sev-
with radical approaches to deep diving. The Swiss eral advantages compared with the older equip-
worker Keller performed an incredible 305-metre ment. A demand system reduces the amount of
dive in the open sea in December 1962 (Figure 1.4). gas used, compared with the standard rig. The
He was assisted by Bühlmann, who developed and ­gas-tight sealing system reduces the chance of a
tested several sets of decompression tables and diver’s drowning by preventing water inhalation.
whose decompression algorithm has been adapted The primary gas supply normally comes to the
and used in many of the early and current genera- diver from the surface or a diving bell and may
tions of diving computers. be combined with heating and communications.
Modern gas mixture sets have evolved as A second gas supply is available from a cylinder
the result of several forces. The price of helium on the diver’s back. Americans Bob Kirby and Bev
has become a significant cost. This, combined Morgan led the way with a series of helmet sys-
with a desire to increase the diver’s mobility, has tems. A model, used for both compressed air and
 Deep diving 11

equivalent to almost 200 metres. Unfortunately,

people paid for this progress. Lives were lost, and
there has been a significant incidence of bone
necrosis induced by these experiments.
In saturation diving systems, the divers live
either in an underwater habitat or in a chamber
on the surface. In the second case, another cham-
ber is used to transfer the divers under pressure to
and from their work sites. Operations can also be
conducted from small submarines or submersibles
with the divers operating from a compartment that
can be opened to the sea. They can either transfer
to a separate chamber on the submarine’s surface
support vessel or remain in the submarine for their
period of decompression. The use of this equip-
ment offers several advantages. The submarine
speeds the diver’s movement around the work site,
Figure 1.5 A Kirby-Morgan 97 helmet. provides better lighting and carries extra equip-
ment. Additionally, a technical expert who is not a
diver can observe and control the operation from
gas mixtures, is shown in Figure 1.5. These helmets within the submarine.
have been used to depths of around 400 metres. Operations involving saturation dives have
Saturation diving is probably the most impor- become routine for work in deep water. The stimu-
tant development in commercial diving since lus for this work is partly military and partly com-
the Second World War. Behnke, an American mercial. Divers work on the rigs and pipelines
­diving researcher, suggested that caisson workers needed to exploit oil and natural gas fields. The
could be kept under pressure for long periods and needs of the oil companies have resulted in strenu-
decompressed slowly at the end of their job, rather ous efforts to extend the depth and efficiency of the
than undertake a series of compressions and risk associated diving activities.
decompression sickness after each. Atmospheric diving suits (ADSs) are small,
A US Navy Medical Officer, George Bond, one-person, articulated submersibles resembling
­
among others, adopted this idea for diving. The a suit of armour (Figure 1.6). These suits are fitted
first of these dives involved tests on animals and with pressure joints to enable articulation, and they
men in chambers. In 1962, Robert Stenuit spent maintain an internal pressure of 1 ATA, so avoiding
24 hours at 60 metres in the Mediterranean Sea off the hazards of increased and changing pressures. In
the coast of France. effect, the diver becomes a small submarine.
Despite the credit given to Behnke and Bond, The mobility and dexterity of divers wear-
it could be noted that the first people to spend ing early armoured suits were limited, and these
long periods in an elevated pressure environment suits were not widely used. The well-known
were patients treated in a hyperbaric chamber. British ‘JIM’ suit, first used in 1972, enabled div-
Between 1921 and 1934 an American, Dr Orval ers to spend long periods at substantial depths.
Cunningham, pressurized people to 3 ATA for up However, these were never fitted with propul-
to 5 days and decompressed them in 2 days. sion units and were replaced by the Canadian
Progress in saturation diving was rapid, with ‘Newtsuit’ and the WASP, which have propellers
the French-inspired Conshelf experiments and to aid movement and can be fitted with claws for
the American Sealab experiments seeking greater manipulating equipment.
depths and durations of exposure. In 1965, the for- In 1997, the ADS 2000 was developed in con-
mer astronaut Scott Carpenter spent a month at junction with the US Navy. This evolution of the
60 metres, and two divers spent 2 days at a depth Newtsuit was designed to meet the Navy’s needs.
12 History of diving

Figure 1.6 Armoured diving suits, past and present (JIM).

It was designed to enable a diver to descend to Cousteau and others. As a sport, diving rapidly
610 metres (2000 ft) and had an integrated dual- spread to Britain and the United States and the
thruster system to allow the pilot to navigate rest of the world.
easily underwater. The ADS 2000 became fully From this beginning, diving has become a
operational and certified by the US Navy in recreational activity that is often combined with
2006 when it was used successfully on a dive to tourism and photography. Others explore caves
610 metres. and wrecks and seek the excitement that deeper
Liquid breathing trials, in which the lungs are and further penetrations provide. Special inter-
flooded with a perfluorocarbon emulsion and the est groups such as cave and technical divers have
body is supplied with oxygen in solution, have developed and in some areas are the modern
been reported to have been conducted in laborato- pathfinders. These groups and their problems are
ries. The potential advantages of breathing liquids ­discussed in greater detail in later chapters.
are the elimination of decompression sickness as
a problem, freedom to descend to virtually any
depth and the possibility of the diver’s extracting FURTHER READING
the oxygen dissolved in the water.
Bert P. Barometric Pressure (1878). Translated
by Hitchcock MA, Hitchcock FA. Columbus,
RECREATIONAL DIVING Ohio: College Book Co.; 1943.
Bevan J. The Infernal Diver. London: Submex; 1996.
Amateur diving started with breath-hold div- Bevan J. Another Whitstable Trade. London:
ing, mainly by enthusiasts in Italy and the south Submex; 2009.
coast of France who were keen spearfishers. This Davis RH. Deep Diving and Submarine Operations.
was also the area where compressed air scuba 6th ed. London: Siebe, Gorman & Co. Ltd.;
diving developed as a result of the work of Hass, 1955.
 Further reading 13

Dugan J. Man Explores the Sea. London: Hamish Shelford WO. Ohgushi’s Peerless Respirator. Skin
Hamilton; 1956. Diver 1972;(Nov):32–34.
Dugan J. World Beneath the Sea. Washington, US Navy Diving Manual Revision 6 SS521-AG-
DC: National Geographic Society; 1967. PRO-010 (2008). Washington, DC: Naval Sea
Marx RF. Into the Deep. New York: Van Nostrand Systems Command; 2008.
Reinhold; 1978.
Ohrelius B. Vasa, the King’s Ship. Translated by This chapter was reviewed for this fifth edition by
Michael M. London: Cassell; 1962. John Lippmann.
Rahn H. Breathhold Diving and the Ama of Japan.
Pub. 1341, National Academy of Sciences.
Washington, DC: National Academy Press;
1965.
 2
Physics and physiology

Introduction 15 Metabolic gas exchange 21

Pressure, gases and diving 15 Inert gas exchange 22
Pressure units 16 Buoyancy 22
Pressure and the diver’s body 16 Energy expenditure 23
Water pressure and lung inflation 17 Altitude and saturation diving 23
Pressure and volume changes 17 Physical aspects of the marine environment 24
Respiration in water and under pressure 19 Heat 24
Temperature and volume changes 19 Light 24
Partial pressures in gas mixtures 20 Sound 25
Solution of gases in liquids 20 Diving gases 25
Gas movement in body tissues 21 Further reading 26

INTRODUCTION is that atmospheric pressure is generated by

­collisions of the molecules of gas in accordance
A basic knowledge of the physics and physiology with the kinetic theory of gases. Either explanation
of diving is essential to understand most of the is acceptable for the following discussion.
medical problems encountered. Aspects of physics The pressure decreases as we move upward
and physiology that have a wide application to div- through the atmosphere and increases as we
ing are discussed in this chapter. move down into a mine or into the sea. At the top
Some of the basic physiological implications are of Mount Everest the atmospheric pressure is
also mentioned, but most aspects of diving physi- about 40 per cent of that at sea level. Because
ology and pathophysiology are relegated to the water is much heavier than air, the pressure
­relevant chapters on specific diving disorders. changes e­xperienced by divers over a particu-
lar depth change are much greater than those
PRESSURE, GASES AND DIVING encountered by climbers or a­viators as they
change altitude.
On the surface of the Earth, we are exposed to the Pressure is measured in a variety of units from
pressure exerted by the atmosphere. This is called either of two reference points. It can be expressed
the atmospheric or barometric pressure. Most with respect to a vacuum, i.e. zero pressure.
people regard this pressure as caused by the mass This reading is called an absolute pressure. The
of the atmosphere pressing down on them. A flaw second method measures pressures above or below
in this argument is that the pressure remains in a local pressure. These readings are called gauge pres-
­bottle after it is sealed, although its contents are sures. At sea level, the absolute pressure is 1 atmo-
contained and are no longer exposed to the column sphere (1 ATA) and the gauge pressure is 0. These
of air above. The physically correct ­explanation units are commonly abbreviated to ATA and ATG.

15
16 Physics and physiology

Common examples are the barometric pressure Pressure units

used by weather forecasters, which is an absolute
pressure, and the blood pressure, which is a gauge Because diving involves facets of engineering and
pressure reading. science, it is plagued with many units of pressure.
With descent in water, pressure increases. For These include absolute and gauge atmospheres,
each 10 metres of depth in sea water, the pressure ­pascals and multiples such as the kilopascal, metres
increases by 1 atmosphere, starting from 1 ATA or or feet of sea water, bars, pounds per square inch,
0 ATG at the surface. The gauge pressure remains torr and several other rarer units. Table 2.1 lists
1 atmosphere less than the absolute pressure. For conversions for the more commonly used units.
example, at 10 metres, the pressure is 2 ATA and
1 ATG. At 90 metres, the pressure is 10 ATA and Pressure and the diver’s body
9 ATG.
Many people have difficulty in understanding why
the pressure of the water does not crush the diver.
Table 2.1 Pressure conversion factors (commonly The answer to this problem may be considered in
used approximations shown in brackets) two parts:
The solid and liquid parts of the body are
1 atmosphere = 10.08 (10) metres sea water
virtually incompressible, so a pressure applied
= 33.07 (33) feet sea water
to them does not cause any change in volume
= 33.90 (34) feet fresh water
and is transmitted through them. After immer-
= 101.3 kilopascals (kPa) sion, the increased pressure pushes on the skin,
= 0.1013 megapascals (MPa) which in turn pushes on the tissues underneath,
= 1.033 kg/cm2 and so the pressure is transferred through the
= 14.696 (14.7) lbs/in2 body until the skin on the other side is pushed
= 1.013 bars back against the water pressure. Therefore, the
= 760 millimetres mercury (mm Hg) system remains in balance. This is in accordance
= 760 torr with Pascal’s Principle, which states: ‘A pres-
= 1 ATA sure exerted anywhere in a confined incompress-
Note: Actual conversions from sea water depth to ATA ible fluid is transmitted equally in all directions
depend on salinity and temperature. A complete throughout the fluid such that the pressure ratio
conversion matrix is provided in Table 2.2. remains the same’.

Table 2.2 Pressure conversions

gm/cm2 mm lb/in2
atm n/m2 or Pa bars mb kg/cm2 (cm H2O) Hg (psi)
1 atmosphere 1 1.013 x 105 1.013 1013 1.033 1033 760 14.70
1 Newton 0.9869 x 1 10−5 0.01 1.02 x 0.0102 0.0075 0.1451
(N)/m2 or 10−5 10−5 x 10−3
Pascal (Pa)
1 bar 0.987 105 1 1000 1.02 1020 750.2 14.51
1 millibar 0.9869 x 100 0.001 1 0.00102 1.02 0.7502 0.01451
(mb) 10−3
1 kg/cm2 0.9681 0.9806 x 105 0.9806 980.6 1 1000 736 14.22
1 gm/cm2 968.1 98.06 0.9806 x 0.9806 0.001 1 0.736 0.01422
(1 cm H2O) 10−3
1 mmHg 0.001316 133.3 0.001333 1.333 0.00136 1.36 1 0.01934
1 lb/in2 (psi) 0.06804 6895 0.06895 68.95 0.0703 70.3 51.70 1
 Pressure, gases and diving 17

However, the effect of pressure on the gas spaces When a diver is using breathing equipment,
in the diver’s body is more complex. The applied pressure at the point from which the gas is inhaled
pressure does not cause any problems if the pressure can be different from the pressure at the chest.
in the gas space is close to that of the surrounding If upright in the water, a scuba diver is inhaling air
water. There is, for example, no physical damage to a released at the pressure at the level of the mouth.
diver’s lungs if the air space was exposed to an inter- A snorkel diver is inhaling air from the surface,
nal pressure of 100 metres of water, provided that and this is at surface pressure. In both these cases,
this pressure is balanced by the pressure exerted by the air is at a lower pressure than the diver’s lungs.
surrounding water acting on the walls of the lung This reduces the amount of air the diver can inhale
to balance any tendency of the lungs to expand. If because part of the inhalation force is used in over-
the lungs were exposed to an internal pressure suf- coming this pressure difference.
ficiently more than the surrounding atmospheric Conversely, when descending, face-down, a
tissue, they would overexpand and burst. diver whose air is released at mouth pressure can
inhale to greater than normal vital capacity but
Water pressure and lung inflation could not exhale to the normal residual volume.
This is because in this orientation, the water pres-
Immersion up to the neck in water reduces vital sure is helping to inflate the lungs.
capacity by about 10 per cent (Figure 2.1 shows
lung volumes). This is caused in part by the hydro-
static pressure of the water compressing the thorax. Pressure and volume changes
With immersion, there is also a loss of gravitational
When a diver descends, the increased pressure of
effects. This reduces the volume of blood in lower,
the surrounding water compresses gas in the gas
mainly leg, veins and increases thoracic blood vol-
spaces within the diver’s body. These spaces include
ume. This change in turn reduces the compliance
the lungs, middle ears, sinuses and intestines.
of the lungs.

6 100

5 2 80
IRV Relaxation
Lung volume (litres)

pressure
4 60 % Vital capacity
VC
Max insp. Max expiratory
1 pressure pressure
3 TV 40
Relaxation
volume
2 20
ERV

1 0
–100 –50 0 50 100 150 200
RV
Pressure (cmH2O)
0

Figure 2.1 Lung volumes and intrapulmonary pressure. The various components of lung volumes are
labelled on the left. On the right, the relationships among lung volume, airway pressure and the maxi-
mum effort that can be made for inhalation and exhalation of air are plotted. Curve 1 is the volume
change during quiet breathing, and curve 2 is the volume change during a maximum inhalation starting
at the residual volume. ERV, expiratory reserve volume; insp., inspiratory; IRV, inspiratory reserve volume;
RV, residual volume; TV, tidal volume; VC, vital capacity. (Redrawn from Lamphier EH, Camporesi EM.
Respiration and exertion. In: Bennett PB, Elliott DH. The phyisology & medicine of diving, 4th edn.
London:WB Saunders Co Ltd; 1993, with permission).
18 Physics and physiology

This is one of the many aspects of diving medicine 10

that is concerned with the relationship between
pressure change and change of gas volume. The
relationship between changes in volume of a gas 8
and the pressure applied to it is described by Boyle’s
Law. This states: ‘if the temperature remains con-

Volume (litres)
stant, the volume of a given mass of gas is inversely 6

proportional to the absolute pressure’. This means

that the absolute pressure multiplied by volume has
4
a constant value, and this constant changes with the
mass of gas considered. To a mathematician, this
means that P × V = K or P1 × V1 = P2 × V2, where
2
P and V are pressure and volume. For example, 10
litres of gas at sea level pressure (1 ATA) will be
compressed to:
0
1 ATA 2 3 4 5 ATA
5 litres at 2 ATA (10 metres). 0m 10 m 20 m 30 m 40 m
2 litres at 5 ATA (40 metres). Pressure depth
1 litre at 10 ATA (90 metres).
Figure 2.2 Effect of Boyle’s Law: While breathing
underwater, the diver’s respiratory volume is about
During ascent into the atmosphere, the reverse
the same as it would be if he or she worked at the
happens and the gas expands. This means that the same rate on the surface. Because of the increase
10 litres of air would expand to 20 litres at 0.5 ATA in density of this breathing gas under increased
(an altitude of about 5000 metres or 18 000 feet) pressure, the diver must move a greater mass of
and to 40 litres at 0.25 ATA (an altitude of about gas with each breath. In some situations, this physi-
10 300 metres or 33 400 feet). cal effect can limit the diver’s capacity to do work.

such as the sinuses or the middle ear. If air entry

Gas volumes expand when pressure decreases
does not take place to equalize pressures, then a
and contract when pressure increases.
pressure difference between the space and the sur-
rounding tissue will develop, with the pressure in
The volume of a mass of gas in a flexible con- the gas space being less than in the surrounding
tainer decreases with pressure or depth increase tissue. The results are ­tissue ­distortion and ­damage,
and expands during ascent or pressure reduc- such as congestion, oedema or haemorrhage.
tion (Figure 2.2). It should be noted that volume During ascent, as the pressure decreases, gas
changes are greatest near the surface. Conversely, within body spaces will expand. Unless gas is vented
gas has to be added if the volume of a container or from the space, the expanding gas will exert pressure
gas space is to remain constant as the pressure is on the surrounding tissue and will eventually dam-
increased. The effects of this law are important in age it. Pressure changes in the middle ear can also
many aspects of diving medicine. result in rupture of the tympanic membrane.
During descent, the increasing pressure in the The same volume changes with pressure occur
water is transmitted through the body fluids to the in bubbles in tissue or blood. Again, the volume
tissue surrounding the gas spaces and to the gas changes are greatest close to the surface. An injury
spaces themselves. The pressure in any gas space in caused by pressure change is called barotrauma.
the body should increase to equal the surrounding
pressure. In the lungs, during descent on breath- Barotrauma is the general name for an injury
hold dives, this is accompanied by a decrease in lung caused by pressure change.
volume. Air should enter cavities with rigid walls,
 Pressure, gases and diving 19

Respiration in water and under Temperature and volume changes

pressure
Charles’ Law states: ‘If the pressure is constant, the
While breathing air underwater, the diver’s respi- volume of a mass of gas is proportional to the abso-
ratory volume is about the same as it would be if lute temperature’.
he or she worked at the same rate on the surface. The absolute temperature (A°) is always 273°
A consequence of this is that a cylinder that con- more than the centigrade temperature. A more
tains enough air for 100 minutes at 1 ATA would useful expression of the law is as follows:
last about 50 minutes at 2 ATA (10 metres) or
20 minutes at 5 ATA (40 metres) for dives with V1 V2 V
= or = K
the same energy expenditure. This is because the T1 T2 T
gas in the cylinder expands to a smaller volume
Where V1 is the volume of a mass of gas at tem-
when it is released against the ambient pressure at
peratures T1°A and V2 is its volume after the tem-
depth than it would if used at the surface. A cylin-
perature has changed to T2°A.
der that contains 5000 litres of gas if it is released
This law has much less relevance to diving
at the sea surface would yield only 1000 litres of
medicine than Boyle’s Law. However, it should be
gas if it is released at 5 ATA, or 40 metres. A div-
remembered when considering gas volumes and
ing physician needs to keep this in mind when
how they may change.
estimating the amount of gas needed for any task
Boyle’s and Charles’ Laws may be combined and
or therapy.
used if temperature and pressure both change –
With depth, gas is compressed and there is an
from P1 and T1 to P2 and T2 with a volume change
increase in density of the gas because there are
from V1 to V2. The combined laws can be expressed
more molecules in a given space. So, at depth,
as the universal gas equation:
a diver must move a greater mass of gas with
each breath. This requires greater effort and
P1 × V1 P2 × V2
involves an increase in the work of breathing. In =
some situations, this can limit the capacity to do T1 T2
work.
A temperature-pressure problem that often
The density of the breathing gas can be
causes discord can be used to illustrate the use of
reduced by replacing nitrogen with a lighter gas
this equation. This is the effect of temperature on
such as helium. For example, the density of air
the pressure in a gas cylinder.
at 1 ATA is about 1.3 kg/cubic metre. At 10 ATA,
A diver may ask to have the compressed air cyl-
the density of air would be about 13 kg/cubic
inder filled to 200 ATA. The gas compressor heats
metre. The use of lighter gas helps to reduce den-
the gas so the cylinder may be charged with gas at
sity. For example, at 40 ATA, the density of a
47°C. When the diver gets in the water at 7°C, the
1 per cent oxygen and helium mixture is 6.7 kg/
diver may find that he or she has only 175 ATA in
cubic metre.
the cylinder. In this case V1 = V2 because the cylin-
As the density of a gas increases, there is an
der is rigid and the pressure falls as the gas cools.
increased tendency for the flow to become turbu-
lent. This causes a further increase in the energy 47°C = 320°A, 7°C = 280°A, V1 = V2
used in breathing. These factors can lead to fatigue
of the inspiratory muscles and reduce maximum 200 × V1 P2 × V2
=
breathing capacity and the work output. To mini- 320 280
mize this load, the body responds by using less P2 = 175 ATA.
gas for a given workload. This can result in the
development of hypercapnia. Continued exposure So the reduced pressure is a result of tempera-
to dense gas, as is encountered in deep dives, may ture change, not a leaking valve or fraud by the air
cause an adaptive response. supplier.
20 Physics and physiology

Partial pressures in gas mixtures be decided that a diver should be given a mixture
with a partial pressure of 0.8 ATA oxygen and
Dalton’s Law states: ‘the total pressure exerted by 1.2 ATA nitrogen in a recompression chamber
a mixture of gases is the sum of the pressures that pressurized to 2 ATA. If oxygen and air are the
would be exerted by each of the gases if it alone only gases available, the gas laws can be used to
occupied the total volume’. The pressure of each calculate how to prepare a cylinder charged with
constituent in a mixture is called the partial pres- the right gas mixture.
sure (Figure 2.3). In air, which is approximately The mixture will need to be 40 per cent oxygen
80 per cent nitrogen and 20 per cent oxygen, the and 60 per cent nitrogen (Dalton’s Law). If the gas
total pressure at sea level (1 ATA) is the sum of the is to be prepared in a cylinder charged to 200 ATA,
partial pressures of nitrogen, 0.8 ATA, and oxygen, it should contain 120 ATA of nitrogen (60 per cent
0.2 ATA. At 2 ATA (10 metres) these partial pres- of 200). If this is to be obtained from compressed
sures will rise to 1.6 and 0.4 ATA, respectively. air (assumed to be 80 per cent nitrogen in this
The partial pressures of breathing gases can be exercise), it will be necessary to put 150 ATA of
manipulated to the diver’s advantage. For example, compressed air into the cylinder (30 ATA of oxy-
the composition of the gas breathed may be modi- gen and 120 ATA of nitrogen) with 50 ATA of
fied to reduce the chance of decompression sick- oxygen.
ness (DCS) by decreasing the percentage of inert This simple mixing process cannot be used as
gas in the mixture. successfully with helium mixtures. At high pres-
Undesirable effects can also occur. Air from an sures, helium does not follow the predictions of
industrial area may contain more than 0.3 per cent Boyle’s Law accurately. It is less compressible than
carbon dioxide and 0.002 per cent carbon mon- the ideal gas described by Boyle’s Law. Mixing can
oxide. If incorporated in compressed breathing be conducted with allowance for this or by putting
gas and delivered at high partial pressures, both a calculated weight of each gas in the cylinder.
constituents could be toxic unless measures were
taken to remove these contaminants before use. Solution of gases in liquids
It may be necessary to combine Boyle’s and
Dalton’s Laws in calculations. For example, it may Henry’s Law states: ‘at a constant temperature,
the amount of a gas that will dissolve in a liquid
(a) is proportional to the partial pressure of the gas
+ + + – – over the liquid’. This law implies that an equilib-
+ – –
+
+
+ – – – rium is established with each gas passing into and
+ + + – – – out of any solution in contact with it (Figure 2.4).
At sea level (1 ATA), an individual’s body tissues
contain about 1 litre of gaseous nitrogen in solu-
(b) tion. If the diver dived to 10 metres and breathed
– + + – +
+
+ – – – –
– –
+ + – + +
– +
Gas Gas
(c)
–
+ – +– + +
+ – + +
– – +
– + + –

Gas in solution Gas in solution

Figure 2.3 Dalton’s Law: (a) two spaces each at
1 ATA; (b) total pressure 1 ATA, 0.5 ATA each
component of the mixture; (c) total pressure
2 ATA, 1 ATA of each component of the mixture. Figure 2.4 Henry’s Law.
 Pressure, gases and diving 21

air at 2 ATA, more gas would dissolve and he or It is the dissolved gas pressures that tend to equil-
she would eventually reach equilibrium again and ibrate, not the number of gas molecules. If a gas
have twice as much nitrogen in solution in the is twice as soluble in one tissue compared with
body. The time taken for any inert gas to reach a another, then twice as many molecules will be in
new equilibrium depends on the solubility of the the first tissue to produce the same partial pressure
gas in the tissues and the rate of gas supplied to in the tissue. This information can be estimated
each tissue. from the solubility coefficients of the gas in the
When the total pressure, or the partial pressure components of the tissue.
of a particular gas, is reduced, gas must pass out The rate of gas movement between two points
of solution. If a rapid total pressure drop occurs, depends on several factors. The difference in par-
a tissue may contain more gas than it can hold in tial pressure and the distance between the two
solution. In this situation, bubbles may form and points may be combined into a concentration
may cause DCS. gradient. The other major factor is the permeabil-
The physiological effects of the solubility of ity of the tissue, an expression of the ease of gas
gases are also relevant in nitrogen narcosis and movement. A large partial pressure between two
oxygen toxicity. points that are close together (a steep gradient)
It should be noted that each gas has a different and a greater permeability both increase the rate
solubility and the amount of any gas that will dis- of gas transfer.
solve in a liquid depends on the liquid. For example,
carbon dioxide is very soluble in water compared Metabolic gas exchange
with other common gases. Beer aerated with com-
pressed air instead of carbon dioxide would have In divers, gas exchange mechanisms are basically
far fewer bubbles. Nitrogen is more soluble in fats the same as at normal pressure. Oxygen diffuses
and oils than in aqueous solutions. down a concentration gradient from the lungs to
Henry’s Law is also time dependent. It takes the tissues. The carbon dioxide gradient is nor-
time for gases to enter and leave solution or form mally in the opposite direction. The exchange
bubbles. If this was not so, champagne would go of inert gases becomes important and there are
flat as soon as the cork was popped. changes in the finer details of metabolic gas
At depth, a diver breathing air absorbs nitrogen exchange.
in accord with Henry’s Law. The amount depends With increasing depth, there is an increase in
on depth and time of exposure. When the diver the partial pressures of the constituents of the
surfaces, the excess nitrogen must pass from the breathing mixture in accordance with Dalton’s
body. If it is eliminated from solution through Law. This causes higher alveolar pressures and
the lungs, there will not be any complications. arterial pressures of the inhaled gases.
In some cases, the nitrogen comes out of solution Elevated pressures of oxygen facilitate oxygen
in the blood or tissues, thus forming bubbles that transport, but they may interfere with the elimi-
may lead to DCS. nation of carbon dioxide in two ways: first, by the
depression of respiration induced by high arterial
Gas movement in body tissues oxygen tensions; and second, by direct interference
with the transport of carbon dioxide. When the
Gas transfer from the lungs to the tissues is depen- inspired oxygen partial pressure is elevated, there
dent on the cardiovascular circulation, and the is an increase in oxygen transport in solution in
gas supplied to a portion of tissue depends on the the plasma (Henry’s Law). When one is inhaling
blood perfusing it. In a permeable substance such oxygen at a partial pressure above 3 ATA, the total
as body tissues, gas molecules can migrate by dif- oxygen requirement may be carried in solution. If
fusion. That is, gas molecules dissolve in the tis- this happens, the haemoglobin may be still satu-
sue fluids and tend to move from areas of high to rated with oxygen in the venous blood, and this
low partial pressure until the partial pressure of can prevent the transport of carbon dioxide in the
the dissolved gas is uniform. This can take hours. form of carbaminohaemoglobin.
22 Physics and physiology

The result is an increased tissue carbon diox- diver weighs more than the weight of water he or she
ide level. In some situations, there may also be an displaces, the diver has negative buoyancy, which
increase in the inspired carbon dioxide pressure. will assist descent and make ascent more difficult.
Causes include contamination of the breathing gas A diver can change buoyancy in several ways.
supply, the external dead space of the equipment, If the diver wears a weight belt, he or she increases
inadequate ventilation or failure of the absorbent weight by a significant amount and displaces only
system. a little more water and, as a result, will decrease
There is a tendency for experienced divers to buoyancy. If the diver displaces more water, he or
be less sensitive to elevated carbon dioxide par- she will increase buoyancy. This can be achieved
tial pressures. This reduces the total ventilation by retaining more air in the lungs. It can also be
requirement during working dives. Elevated achieved by inflating the diver’s buoyancy com-
­arterial carbon dioxide levels increase suscep- pensator device (BCD) – a device used to control
tibility to oxygen toxicity, DCS and inert gas buoyancy. It has an air space that the diver can
narcosis. For these reasons, it is desirable to
­ inflate or deflate to make him positively, negatively
control the f­actors that cause carbon dioxide or neutrally buoyant, as needed.
retention. An interesting combination of the effects of
Boyle’s Law and Archimedes’ Principle is shown
Diving is associated with a tendency to retain by the changes in buoyancy experienced by a diver
carbon dioxide. wearing BCD or a compressible suit. If slightly posi-
tively buoyant at the surface with air in the BCD, the
diver will experience some difficulty in descending.
Inert gas exchange As the diver descends he or she will pass through a
zone where he or she is neutrally buoyant and, if the
The topic if inert gas exchange is considered in the diver descends further, he or she will become nega-
chapters on DCS. Therefore, to avoid duplication, the tively buoyant. The increased pressure reduces the
topic is not considered in detail here. As indicated volume of gas in the BCD or suit, the volume of fluid
earlier, increased total pressure is usually accompa- displaced and, consequently, the diver’s buoyancy.
nied by an increase in nitrogen (and/or other inert The weight of a scuba cylinder decreases as gas is
gas) pressure (Dalton’s Law). This causes gas transfer consumed from it, and this will lead to an increase
to the body tissues. When pressure is reduced at the in buoyancy. An empty cylinder can weigh 1 to 2 kg
end of the dive, the transfer is reversed. If there is an less than a full one, depending on the initial pressure
excess of gas, then it can come out of solution as bub- and the size and type of the ­cylinder (e.g. steel, alloy).
bles. These bubbles are the cause of DCS. If bubbles Immersion creates a condition resembling the
do occur, they are also subject to the same physical gravity-free state experienced by astronauts. In air,
laws. Their size decreases if the pressure is increased, a standing person has a pressure gradient in the
and gas enters or leaves them depending on the con- ­circulation where the hydrostatic pressure is great-
centration gradients of gases. est at the feet and least at the head. For an immersed
diver, the hydrostatic gradients in the circulatory
BUOYANCY system are almost exactly counterbalanced by the
ambient water pressure. This reduces the volume of
Archimedes’ Principle states: ‘any object, wholly or pooled blood in the leg veins. In addition, ­peripheral
partially immersed in liquid, is buoyed up by a force vasoconstriction will occur in response to any cold
equal to the weight of liquid displaced’. A diver is an stress. These changes result in an increase in central
object immersed in water and is therefore affected blood volume, leading to diuresis and subsequent
by this principle. It determines the effort the diver haemoconcentration and decreased plasma volume.
must make to dive. If a diver weighs less than the The effect of haemoconcentration on normal
weight of water he or she displaces, the diver will dives is not major except that it gives divers a
tend to float to the surface – i.e. he or she has posi- physiological excuse for well-developed thirst and
tive buoyancy, which makes descent difficult. If the sometimes the need to urinate. Urine production
 Altitude and saturation diving 23

rates of more than 300 mL/hour cause problems It may be expected that the higher oxygen par-
for divers trying to keep their dry suit dry, unless it tial pressures in hyperbaric environments could
is fitted with a relief outlet. improve physical performance. However, chamber
The other effect of increased central blood experiments, in which the subjects exercised while
volume is on cardiac performance. There is an breathing oxygen at 3 ATA, showed that the maxi-
increase in cardiac output as a result of increased mum aerobic work performance was not signifi-
stroke volume. Immersion alone, or in combina- cantly increased.
tion with various other factors associated with the
diving environment, can precipitate cardiovascu- ALTITUDE AND SATURATION
lar dysfunction in susceptible individuals. This is DIVING
discussed in Chapter 39.
Our normal idea of diving is that a diver descends
ENERGY EXPENDITURE from sea level, 1 ATA, and returns when the
dive has finished. There is a series of variations
Measurements of energy expenditure, while swim- from this situation. A diver may have to dive in
ming on the surface and underwater, have been a mountain lake where the pressure on the sur-
made using indirect calorimetry and by predic- face is less than 1 ATA. Another variation occurs
tion from heart rate. These results show that when a diver starts from an environment where
oxygen consumption underwater of more than the pressure is greater than 1 ATA. This happens
3 litres/minute (lpm) is possible, and values greater when divers operate from a pressurized compart-
than 2 lpm are quite common. The diver’s energy ment or underwater habitat. These conditions
expenditure when inactive may be lower than introduce complexities that require understand-
found on land, presumably because the absence of ing of the physics involved.
gravitational effects reduces the energy required to A diver operating in a high mountain lake is
maintain posture underwater. returning to a lower surface pressure than a diver
Typical gas consumption and energy expendi- at sea level. This decreases the pressure at which the
ture levels are as follows: diver is while releasing inert gas after a dive and so
For a slow swim, 0.5 knots, the diver would have increases the tendency to form bubbles. Therefore,
an air consumption of 20 lpm and an oxygen con- the diver may need to modify the decompression
sumption of 0.8 lpm. A swim of 0.8 knots would plan. Another minor correction will be required
cause an air consumption of almost 40 lpm and if it is a fresh water lake. Fresh water is less dense
an oxygen consumption of 1.4 lpm. A fast swim than salt water, so the diver is exposed to a slightly
of 1.2 knots would cause an oxygen consump- lower pressure change per unit depth.
tion of about 2.5 lpm and an air consumption of In addition, this diver will have to exhale
60 lpm (air consumption measured at the depth faster during ascent. A diver who ascends from
the diver was swimming and oxygen consumption 10 metres (2 ATA) to the surface (1 ATA) with-
at 1 ATA). out exhaling would find that the volume of gas
Increased gas density increases the work of in the lungs has doubled. Most divers realize this
breathing. This increases the resistance to gas flow and exhale at an adequate rate during ascent.
through the diver’s airways and breathing appara- However, they may not realize that a similar
tus, increases the work of breathing and reduces doubling in gas volume occurs during the last
ventilatory capacity. A maximum breathing gas 5 metres of ascent to the surface, if the pressure
density (helium) of around 8 g/litre appears to be at the surface was 0.5 ATA.
realistic for practical purposes, thus limiting div- High-altitude diving may require that the depth
ing to around 400 to 500 metres for useful work. or duration of dive and the rate of ascent be reduced
to allow for the lower than normal surface pressure
Gas density may prove to be the limiting at the end of the dive. Tables are available for div-
­factor for deep diving. ing at higher altitudes, and many dive computers
are programmed to compensate for this.
24 Physics and physiology

A diver living in a human-made environment The heat transfer by conduction is also increased
where the pressure is high can operate to deeper in a helium environment. The result is that a
than normal depths. This system is used in satura- helium diver may need external heating to main-
tion diving, where the diver operates from a base at tain body warmth at a water, or gas, temperature
increased pressure and becomes equilibrated with where external warming would not be required if
it. The eventual return to the surface can take many the diver was in an air environment.
days. The use of such environments has proved to In warm environments, it is possible for a diver
be invaluable where deep or long dives are required to suffer heat stress. A diver who is wearing a pro-
(see Chapter 67). tective suit cannot lose heat by sweating because
Another pressure-related problem can occur the sweat cannot evaporate. In a pressure chamber,
when a diver dives and then flies or ascends into the atmosphere can become saturated with water,
mountains. Some dives and ascents will require and evaporative cooling is prevented. The heat
the diver to ensure that adequate time is spent at stress for a given temperature is also increased if
the surface before ascending to high altitude, to there is helium in the mixture.
avoid DCS. This problem is encountered by a diver Despite wearing thermal insulation in warm
tourist who wants to fly home after diving or one tropical waters, divers can continue to lose heat
who needs to pass over hills or mountains when over several days of repetitive diving, and ‘silent’
returning from a dive. It is also encountered when hypothermia can develop, somewhat insidiously.
it is necessary to transport a diver with DCS. There
may be an increase in manifestations of DCS when
the pressure is decreased, even by a relatively small A diver in water or a helium-rich environment
amount. can cool or heat up at a temperature that
would be comfortable in an air environment.

PHYSICAL ASPECTS OF THE

MARINE ENVIRONMENT
Light
Heat
Even in the cleanest ocean water, only about
Diving and exposure to high pressures change 20 per cent of the incident light reaches a depth of
the heat transfer from a diver’s body. In air, there 10 metres and only 1 per cent reaches 85 metres.
is some insulation from the air trapped near the Clean water has a maximum transparency to light
body, either by the clothes or the hair and the with a wave length of 480 millimicrometres (blue).
boundary layer. In water this is lost. The water This variation of absorption with wave length
adjacent to the skin is heated, expands slightly, and causes distortion of colours and is responsible for
causes a convection current that tends to remove the blue-green hues seen at depth. Red and orange
the layer of warmed water. This process is acceler- light is absorbed most. Because of the absorption of
ated by movement of the diver or the water. The net light, the deep ocean appears black, and lights are
result is that a diver cools or heats up much more needed for observation or photography. Because of
quickly than he or she would in air of the same the greater absorption of reds by water, some illu-
temperature. mination is needed to see the true colours, even
Heat loss is also increased in warming the at shallow depths. Part of the appeal of diving at
cooler inhaled air or gas. For a diver breathing air, night is that objects that have a blue-green colour
most of this heat is used to humidify the dry air in natural light have a new brightness when they
used for diving and is not sufficient to cause con- are illuminated with a torch.
cern in most circumstances. However, the heat lost Coastal water, with more suspended material,
in a helium dive is more significant. Helium has has a maximum transparency in the yellow-green
a greater specific heat than nitrogen. The problem band, about 530 millimicrometres. Absorption and
is compounded because at depth, the mass of gas scattering of light by suspended particles restrict
inhaled is increased. vision and can tend to even out illumination.
 Diving gases 25

Air Water

Light rays

Eyes

Glass of Apparent Actual

face mask position position
or helmet

Figure 2.5 Displacement of image in water.

This can make the light intensity the same in all sounds travel farther than higher-pitched sounds.
directions and is an important factor in causing Transmission of sound is enhanced by reflection
loss of orientation. from the surface. This reflection also enhances the
When the eye focusses on an object in air, most transmission of sound in air over water but reduces
of the refraction of light rays occurs at the air– the transmission of sounds from air to water and
cornea interface. In water, this refractive power is from water to air.
lost and the eye is incapable of focussing. A face Both high-pressure air and helium-oxygen
mask provides an air-cornea boundary, which mixtures cause speech distortion. This is greater
restores refraction at the cornea surface to nor- when breathing helium mixtures and can render
mal. Refraction also occurs at the face mask sur- speech unintelligible. Distortion in air causes the
face, mainly at the glass–air boundary. This results voice to become more nasal and crisp as the pres-
in an apparent size increase of about 30 per cent sure increases.
and this makes objects appear closer than they It is often thought that divers cannot talk under-
are. Practice and adaption of the hand–eye co-­ water. This is not so if the diver has an air space to
ordination system allow the diver to compensate speak into. Helmet divers can communicate eas-
for this distortion, except when describing the size ily by touching their helmets together and using
of fish (Figure 2.5). the air-metal-air pathway. Some scuba divers have
Masks also restrict vision by narrowing the mastered the art of talking by taking their demand
peripheral fields, and they distort objects that sub- valve from their mouth and speaking into an air
tend large visual angles. Both absorption of light space created by cupping their hands.
by water, which reduces apparent contrast, and
scattering by suspended particles reduce visual DIVING GASES
acuity. Attempts have been made to improve the
diver’s vision by modification of the face mask, the Most diving is based on the use of compressed air
use of coloured filters, ground mask lenses and and other oxygen–nitrogen mixtures as a breathing
contact lenses. These can be relatively successful gas. Commercial, military, technical and experi-
but can also impose their own problems. mental diving may involve the use of other gas
mixtures. For this reason, it is desirable to give the
Sound reader some salient points on the gases mentioned
in this text and related literature.
Sound in water is transmitted as waves with a lon- Oxygen (atomic weight 16, molecular weight 32)
gitudinal mode of vibration. The speed of sound is the essential constituent of all breathing mix-
is about 1530 metres/second in sea water and tures. At high altitude people survive with less than
1470 metres/second in fresh water at 15°C. Water is 0.1 ATA in their inspired air. However, for diving,
a better transmitter of sound than air, so sounds ­oxygen should be present at a partial p
­ ressure of at
travel greater distances under water. Low-pitched least 0.2 ATA to avoid hypoxia. At higher partial
26 Physics and physiology

pressures oxygen causes oxygen toxicity. Prolonged processing to make it understandable because of
exposure to more than 0.55 ATA causes pulmonary the distortion. A diver in a helium atmosphere is
oxygen toxicity, and shorter exposure to more than more susceptible to heat and cold because the high
about 1.5 ATA results in central nervous system thermal conductivity speeds the transfer of heat
effects. The risk of these problems may be accept- to and from the diver. The other problem with the
able in a recompression chamber, where oxygen use of helium is that it is associated with a disorder
may be used at partial pressures of up to 2.8 ATA. called the high-pressure neurological syndrome
Oxygen toxicity is discussed in Chapter 17. (HPNS) (see Chapter 20).
In the range 0.2 to 2.8 ATA, oxygen has little Hydrogen (atomic weight 1, molecular weight 2)
effect on the respiratory centre and minute volume has the advantage of being readily available at low
will remain close to normal. Oxygen is vasoactive; cost. Because of its lightness it is the easiest gas to
high oxygen tensions cause vasoconstriction. breathe. These factors may lead to its use as a replace-
Nitrogen (atomic weight 14, molecular weight 28) ment for helium. The reluctance to use stems from
is the major component of air – about 79 per cent. fears of explosion. Explosions can be prevented if
Nitrogen is often considered to be physiologically the oxygen level does not exceed 4 per cent, and
inert. Bubbles, composed mainly of nitrogen, can such a mixture is breathable at depths in excess of
cause DCS if a diver who has been breathing air or 30 metres. Hypoxia can be p ­ revented by c­ hanging
an oxygen–nitrogen mixture ascends too rapidly. In to another gas near the surface. Hydrogen causes
solution, it may cause nitrogen narcosis at depth (see thermal and speech distortion problems similar to
Chapter 15). At partial pressures of nitrogen greater those encountered with helium.
than about 3 ATA, there is a demonstrable decrement
in the diver’s performance. At higher partial pres- FURTHER READING
sures, the effect is likely to cause the diver to make
mistakes. The other problem that restricts the use Brubakk AO, Neuman TS (eds). Bennett and
of nitrogen is that its density at increased pressure Elliot’s Physiology and Medicine of Diving.
increases the work of breathing. 5th ed. Philadelphia: Saunders; 2004.
Despite these disadvantages, nitrogen is of Doolette DJ, Mitchell SJ. Hyperbaric condi-
major importance in diving, at depths less than tions. In: Pollock DM (ed). Comprehensive
50 metres and as a part of more complex mixtures Physiology. Vol 1. New York: Wiley; 2011.
at greater depths. http://www.comprehensivephysiology.com/
Helium (atomic weight 4) is a light, inert gas. It WileyCDA/
is found in natural gas wells in several countries. US Navy Diving Manual Revision 6 SS521-AG-
Helium is used to dilute oxygen for dives to depths PRO-010 (2008). Washington, DC: Naval Sea
greater than 50 metres, where nitrogen should not Systems Command; 2008. (Vol. 1, Chapters 2
be used alone. The two major advantages of helium and 3 deal with these topics in a manner that
are that it does not cause narcosis and, because of assumes no previous knowledge.)
its lightness, helium-oxygen mixtures are easier Schilling CW, Werts MF, Schandelmeier NR
to breathe than most alternatives. Helium-oxygen (eds). The Underwater Handbook: A Guide to
mixtures can allow a shorter decompression Physiology and Performance for the Engineer.
time (albeit often with a different profile) than an New York: Plenum Press; 1976.
equivalent saturation dive with the diver breath-
ing air because helium diffuses more rapidly than This chapter was reviewed for this fifth edition by
nitrogen. John Lippmann.
The use of helium can cause several problems.
The speech of a diver at depth may need electronic
 3
Free diving

Introduction 27 Oxygen stores 33

Humans as free divers 27 Oxygen consumption and the diving
The challenge of increasing depth 28 response 34
The challenge of increasing duration 29 Anaerobic metabolism 35
The challenge of avoiding gas toxicities Diving technique 35
and decompression sickness 32 Pressure changes 35
Record diving 32 Hypothermia 35
Diving marine mammals 33 Further reading 35

INTRODUCTION snorkel, fins, wetsuit and weights and carry a spear

gun, knife and bag. Competitive free divers may
Free diving refers to dives made from surface to also employ specialized devices such as weighted
­surface during voluntary apnoea on a single breath. sleds for descent and inflatable lift bags for ascent
No underwater breathing apparatus is used. Free to achieve remarkable depths. Even with such mod-
diving (also often referred to as ‘breath-hold div- ern specialized equipment, human diving capabili-
ing’ or ‘snorkel diving’) is regarded as the purest ties are paltry in comparison with those of marine
and most natural form of diving. Unencumbered by mammals and other sea animals (Table 3.1).
bulky equipment, the diver is free to move weight-
lessly and silently in the underwater world. Practised
HUMANS AS FREE DIVERS
in some societies for thousands of years, free diving
in its simplest form requires no equipment at all. The You’re running on reserve tank and
introduction of various p ­erformance-enhancing there’s no warning before you hit empty!
apparatus such as face masks, fins, weight belts,
buoyancy vests and thermal protection suits may Record-holding free diver
present new problems. For example, the addition
of goggles or face masks allows for clear vision but There are two principal (and somewhat inter-
introduces a gas space that must be ‘equalized’ to related) challenges in free diving:
prevent barotrauma. Near the surface, wetsuits gen-
erate positive buoyancy that decreases as they are 1. The challenge of increasing depth, with its
compressed during descent. If a weight belt is used attendant risk of pressure-related injury to gas-
to offset the initial positive buoyancy of the wetsuit, containing spaces.
this will render the diver negatively buoyant as he 2. The challenge of increasing duration, with its
or she begins the ascent. Nevertheless, recreational attendant risk of exhaustion of oxygen (O2)
free divers and spearfishers often wear a mask, stores.

27
28 Free diving

Table 3.1 Depth penetrations of human divers and marine animals

Comparative depth penetrations Depth (m)

Human free (breath-hold) diver
• ‘Constant ballast no fins’ 101
• ‘No limits’ 214
Human diver using underwater breathing apparatus
• Bounce dive (surface to surface) 318
• Saturation diving lockout from bell >400
Sperm whale 1150
Northern elephant seal 1500
Wreck of Titanic 3810
Octopus species 5639
Deepest known fish 7703
Amphipod crab 9789
Deepest manned submersible dive 10 911
Deepest part of ocean ~11 000

A third challenge that is most relevant to the would be compressed to the residual volume
more extreme exponents of free diving is the (1.5 litres), a simple application of Boyle’s Law.
related exposure to markedly elevated gas partial A corollary was that divers with a larger total
pressures with related risks such gas toxicities and lung capacity and/or a smaller residual volume
decompression sickness. would be capable of greater depths before injury
occurred.
The challenge of increasing depth The fallacy of the ‘residual volume limit’ is
immediately clear when it is considered that a
Any anatomical or equipment gas spaces are ­subject human has descended to 214 metres (22.4 atmo-
to compression during descent, and their volumes spheres absolute [ATA]) without suffering obvi-
may need to be compensated if barotrauma is to be ous lung barotrauma and that free divers regularly
avoided. Obvious examples, which are discussed descend to depths greater than a theoretical maxi-
elsewhere in this text, include the middle ear (see mum calculated in this way. The factors that were
Chapter 7), sinuses (see Chapter 8) and mask. missing from these early attempts to predict maxi-
The lung is of particular relevance to free divers mum depth were the distensibility of the pulmo-
because, unlike divers using underwater breathing nary vasculature and the concomitant potential for
apparatus who compensate intrapulmonary pres- intrapulmonary blood pooling to compensate for
sure and volume with each breath of compressed compression of lung volume, effectively allowing
gas, the lung volume of a free diver is progressively for compressions below predicted residual volume.
compressed as depth increases. The beginnings of such compensation can be seen
It was long believed that the limiting factor on with simple head-out immersion in an upright
depth in free diving would be the point at which subject. The negative transthoracic pressure gen-
lung volume was compressed to residual volume erated by having the airway open to a pressure of
because compression to smaller volumes could, 1 ATA while the thorax is exposed to greater pres-
logically, result in trauma to the chest wall or sure (because of the surrounding water pressure)
lung itself. Thus, a diver with a total lung ­capacity results in a shift of about 0.7 litre of blood into the
of 6 litres and a residual volume of 1.5 litres thorax. A greater engorgement of the pulmonary
should t­ heoretically be able to breath-hold dive to circulation is likely if the transthoracic pressure
30 metres (4 ATA) where the total lung volume increases further.
 Humans as free divers 29

Notwithstanding this remarkable and fortu- often done in the mistaken belief that it signifi-
nate mechanism for compensation, there will nev- cantly enhances O2 stores. Although hyperven-
ertheless come a point where pulmonary vascular tilation does increase the alveolar O2 content to a
capacitance is maximized and further descent small extent, the volume of O2 involved is effec-
will cause the lung’s remaining gas volume to tively inconsequential. What hyperventilation can
develop an increasingly negative pressure relative achieve is a marked lowering of arterial CO2 levels.
to the environment and surrounding tissue. If this Competitive breath-hold divers have had end-tidal
becomes excessive, then both fluid extravasation CO2 pressures as low as 20 mm Hg measured at the
from capillaries to the alveolar space and frank end of their typical pre-apnoea routine. This has
haemorrhage are possible, and there is evidence the effect of prolonging the breath-hold duration
from competitive free diving that both occur. This before the onset of a strong urge to breathe.
problem is referred to as pulmonary barotrauma The obvious danger associated with hyperven-
of descent or ‘lung squeeze’. Although it is inter- tilation is that it will extend the breath-hold dura-
esting and potentially of increasing importance as tion closer to the point where the arterial Po2 falls
free diving depths are extended, this is currently a below that required to maintain consciousness.
minor contributor to free diving accidents in com- There is little doubt that hyperventilation has been
parison with the challenges of increasing duration a contributory factor in many free diving deaths.
underwater. There is also some evidence that well-practised free
divers can induce a decrease in sensitivity of the
The challenge of increasing duration medullary respiratory control centre to CO2, or
they can learn to resist the uncomfortable urges to
It is self-evident that oxygenation is maintained breathe that CO2 generates as its arterial pressure
from steadily dwindling O2 stores during a free rises, or both. Interestingly, however, although
dive. In contrast to marine mammals, a human’s competitors in static apnoea events (effectively
stores are relatively small. The total O2 stores in breath-holding competitions without pressure
a 70-kilogram man at resting lung volume (func- change) aggressively employ hyperventilation and
tional residual capacity) have been calculated to are highly motivated not to breathe for as long as
be approximately 1.5 litres. This store would be possible, symptomatic hypoxia is not frequent as
increased at total lung capacity whose value is vari- would be expected. This brings the discussion to
able among individuals. If nearly all this O2 can be changing ambient pressure during a free dive as
extracted, one could predict that a resting man an added and significant risk factor for critical
who has an O2 consumption of 300 mL per minute hypoxia.
would completely deplete his O2 stores in 5 min- Arterial gas tensions during breath-hold dives
utes. In reality, most untrained humans can only change with the partial pressure of the gases in the
breath-hold for approximately 1 minute because lungs. When the breath-hold diver descends, the
the drive to breathe is dependent largely on rising partial pressures of the gases in the lungs increase
pressures of carbon dioxide (CO2) rather than fall- as their volume is decreased and gas inside is com-
ing levels of O2 (although the two are synergistic). pressed. The reverse takes place during ascent back
This inherent inability to breath-hold voluntarily toward the surface. This leads to concomitant rises
to the point of critical hypoxia (an arterial partial and falls in alveolar and arterial Po2.
pressure of O2 [Po2] above approximately 25 mm Figure 3.1 shows alveolar pressures of the meta-
Hg must be maintained to avoid loss of conscious- bolic gases during (a) a breath-hold period without
ness) is clearly protective in free diving. However, ambient pressure change, (b) a breath-hold dive to
it can be confounded in two important ways: by the 10 metres and (c) a breath-hold dive to 10 metres
use of hyperventilation before breath-holding and with prior hyperventilation. In Figure 3.1 (b) and
through the effects of changing ambient p­ressure 3.1 (c), ambient and thus alveolar gas partial pres-
during descent and ascent from a free dive. sures rise during descent according to Boyle’s Law.
Hyperventilation refers to taking a series of The rise in O2 is somewhat reduced because of con-
rapid deep breaths before breath-holding. This is tinued consumption. Because of the high alveolar
30 Free diving

200 60

Alveolar carbon dioxide tension

CO 2

Alveolar oxygen tension

150
40

(mmHg)

(mmHg)
Oxy
100 ge n

20
50

Hypoxic zone

Time (s) 0 20 40 60 80
(a)

200 60
CO

Alveolar carbon dioxide tension

2
Alveolar oxygen tension

Oxy
150 gen
40
(mmHg)

(mmHg)
100

20
50

Hypoxic zone

Time (s) 0 20 40 60 80
Descent On bottom Ascent
2 ATA
(b)

200 60

Alveolar carbon dioxide tension

CO2
Alveolar oxygen tension

150
40
(mmHg)

(mmHg)
Oxy
100 g en

20
50

Hypoxic zone

Time (s) 0 20 40 60 80

Descent On bottom, 2 ATA Ascent

(c)

Figure 3.1 Alveolar pressures of the metabolic gases during (a) a breath-hold period without ambient
pressure change, (b) a breath-hold dive to 10 metres and (c) a breath-hold dive to 10 metres with prior
hyperventilation.

Po2 at depth, there is a sufficient alveolar-arterial volume of the alveolar gas increases. This is greater
gradient to allow continuing O2 uptake for a con- than expected from gas laws alone, thus reflecting
siderable time. ongoing oxygen metabolism. The dive with prior
In contrast, during ascent there is a rapid fall hyperventilation depicted in Figure 3.1 (c) had a
in alveolar Po2 as the lung re-expands and the longer bottom time as would be expected when
 Humans as free divers 31

prior lowering of the arterial CO2 makes the diver interview William Trubridge, holder of the constant
more comfortable remaining at depth for longer. ballast no fins world depth record of 101 metres,
It can be seen that a lower alveolar partial pres- articulated it thus:
sure of O2 develops by the time the diver reaches
the surface, and such falls in alveolar and arterial The training I do is targeted at creat-
Po2 during ascent would be even more dramatic ing a physiology that conserves oxygen
on deeper dives. The obvious risk is that the diver as much as possible. Whereas some-
could experience critical arterial hypoxaemia one who is extremely fit would be able
as the alveolar Po2 is rapidly falling in the latter to supply a high amount of oxygen to
stages of the ascent. Indeed, loss of conscious- their muscles very quickly, I need to shut
ness during either the final phase of ascent or on down that oxygen flow to the muscles
arrival at the surface is a recurring event at free so that they can work anaerobically and
diving competitions. The dangers of breath-hold that conserves the oxygen for the heart
diving and hyperventilation are discussed further and the brain. Physiology for freediving
in Chapter 16. is such a different set of effects to what
In addition to hyperventilation, there are two is found in any other sport that we’re still
other strategies, both controversial, that elite free discovering exactly what they consist of.
divers use or manipulate in order to extend their
duration underwater. New Zealand Listener Magazine,
The first of these is an attempt to expedite the 4 January 2014
so-called diving reflex that can be observed in all
air breathing vertebrates but that is highly devel- Similarly, on his website Francesco “Pippin”
oped in marine mammals (see later). This reflex is Ferreras, a previous world record holder, described
initiated by apnoea and also by facial cooling. Its his approach in more detail:
principal effector arm is a marked sympathetically
mediated increase in peripheral vascular resistance My heart, under direct control of the
that increases blood pressure and in turn elicits a Central Nervous System, begins a rapid
vagally mediated bradycardia. At the same time, slowdown. This diminution of my cardiac
there is some evidence that the sympathetic activa- output is a result of the body’s decreas-
tion induces splenic contraction, increasing circu- ing needs for oxygen and energy con-
lating red blood cells. Peripheral vasoconstriction sumption. This efficiency in energy
has the effect of reducing the circulation of blood conservation is of vital importance for
to the peripheries, and the bradycardia reduces O2 survival in the undersea environment
consumption by the heart. Central redistribution while in a state of apnea. As an example,
of blood makes more O2 available to vital organs. when I begin my pre-­immersion prepa-
A concurrent and unwanted side effect of these rations my resting heart rate is 75 bpm,
processes is a predisposition to arrhythmias. This 10 minutes after entering a stare of
probably arises from vagal inhibition of nodal con- deep relaxation it drops, to 55 bpm. As I
duction combined with sympathetic sensitization begin my descent, in a matter of sec-
of ectopic pacemakers. Not surprisingly, ventricu- onds it has slowed to 30 bpm. My car-
lar ectopic beats are common. diovascular performance is ­ influenced
Although these are autonomically mediated phe- by other factors, foremost being my
nomena, there is a strong belief among free divers physical conditioning, and mental
that they can manipulate the process through con- preparation.... Once I have reached a
ditioning, relaxation techniques and practice. Given depth of 110 m., I institute one last com-
that there is considerable inter-subject v­ariability mand to my heart to slow down. At this
in the potency of the diving reflex, and that it tends point my heart is down to a mere 10 to
to wane with age, it does seem plausible that it is 14 bpm. On several immersions when
‘open’ to manipulation by skilled ­divers. In a 2014 all of the above mentioned factors are
32 Free diving

ideal I have obtained readings of an The challenge of avoiding gas

incredible 7 bpm! Obviously these find- toxicities and decompression
ings are augmented by the power of
sickness
mind over body that I have developed
over the years, through the study and The combination of increasing depth and dura-
practice of Yoga. tion (particularly the former) during free diving
opens up the possibility that extreme exponents
The second controversial strategy used by will suffer gas toxicities and decompression sick-
elite free divers to extend both depth and dura- ness, complications usually associated with com-
tion underwater is so-called ‘lung packing’, more pressed gas diving. Neurological decompression
correctly referred to as glossopharyngeal insuffla- sickness in breath-hold divers has been reported.
tion. This technique involves using the glossopha- Although some cases may be caused by arterial
ryngeal muscles to pump air into the lungs, thus gas embolism following pulmonary barotrauma,
enabling an increase in the total lung capacity by predictions of inert gas tensions following
up to 20 per cent. This extra volume potentially repeated and closely spaced deep breath-hold
increases the depth at which lung compression dives do suggest that pathological bubble forma-
becomes hazardous (as described earlier) and tion from dissolved inert gas is certainly possible
also represents an increase in the O2 stores. Adept (see Chapter 10).
exponents of lung packing can increase the vol- Despite the extreme depths reached by free div-
ume of air carried by several litres, although this ers, overt effects of nitrogen narcosis are only rarely
does not translate directly into an increase in lung reported, although there may be a strong report-
volume because the gas is held in the lungs under ing bias operant here. It may also be that narcosis
positive pressure and is therefore compressed. is not as likely as predicted on the basis of depth
Therein lies the potential problem with this strat- alone simply because the partial pressure of nitro-
egy. There are sporadic reports of excessive pack- gen in the relevant tissues takes time to equilibrate
ing leading to pulmonary barotrauma because with the partial pressure of nitrogen in the lungs,
of the high positive transpulmonary pressures and the short duration of the dives therefore lim-
that can reach 60 mm Hg or even more. There its any effect. Nevertheless, as extreme free divers
are also reports of hypotensive loss of conscious- are pushing deeper, there are increasing numbers of
ness resulting from profound reduction in venous stories of strange sensations and ‘funny turns’ dur-
return associated with high intrathoracic pres- ing these dives. It is impossible to know their exact
sure during the act of packing. In view of these cause, but potential explanations include nitrogen
potential hazards the technique cannot be recom- narcosis (see Chapter 15), high-pressure neurologi-
mended. Nevertheless, it is unlikely that packing cal syndrome (see Chapter 20) and cerebral O2 tox-
will be abandoned by extreme free divers looking icity (see Chapter 17). Cerebral O2 toxicity seems an
for any possible edge. unlikely explanation given the very short exposures,
Largely for completeness (and for curious inter- the starting fraction of inspired O2 of 0.21 and the
est value), there are some extreme free divers who fact that O2 is being consumed from the moment
have developed the technique of glossopharyngeal apnoea begins. However, some reported events (e.g.
exsufflation, that is, packing in the opposite direc- facial or diaphragmatic twitching) are very typical
tion. This is used in those situations near terminal of O2 toxicity. These sorts of problems are likely to
depth when the lungs are compressed at or below become more common as record depths are pushed
residual volume, and it is therefore impossible to further.
generate a Valsalva manoeuvre to clear the ears
or sinuses. An alternative approach to avoiding Record diving
barotrauma under these conditions, and one that
has been proven radiologically, is to let the sinuses Trained free divers have been able to achieve
(and to some extent the middle ears) flood with remarkable underwater feats, and in certain soci-
water! eties these divers are accorded celebrity status.
 Diving marine mammals 33

Records are attempted for various categories of swimmers) and 234 metres (female swimmers)
diving involving depth, duration and underwater have been achieved in 50-metre swimming pools
distance. Because of the potential risks involved, with swimmers using fins for propulsion.
dedicated competitions sanctioned by an umbrella
society are run according to strict protocols. DIVING MARINE MAMMALS
Physiologists and physicians need to be aware of
these remarkable achievements. The records cited The study of diving animals offers the scientist an
here are valid for January 2015 but may have been ideal opportunity to study the physiological con-
superseded at the time of reading. A complete sequences and defence mechanisms required to
list of current records is available at: http://www.­ survive extended breath-holding. It is also of great
aidainternational.org/competitive/worlds-records. interest to diving physicians to see how diving ani-
The purest form of depth record is referred to as mals avoid the perils induced by exposure to pres-
constant weight apnoea without fins and involves sure and hypothermia.
return to the surface with the same weights car- The northern elephant seal and the sperm whale
ried down (if any) and, as the name implies, no use can dive to 1500 metres. The southern elephant
of fins. The record is currently 101 metres for male seal can stay submerged for 2 hours, although
divers and 69 metres for female divers. usual dives are 20 to 30 minutes in duration. The
At the opposite end of the spectrum is so-called Weddell seal regularly dives for food to greater
no limits free diving. This is the most extreme cate- than 100 metres and can remain submerged for up
gory in respect of depth and requires no swimming to 60 minutes. Typical humans, with some prac-
at all. Divers hold onto a weighted, rope-guided tice, can breath-hold underwater for 1 to 2 minutes
sled for descent. On reaching the target depth, they and descend to 10 to 15 metres.
detach themselves from the sled and pull a pin that How are marine mammals able to achieve
releases compressed air from a cylinder into a lift these remarkable underwater depth and/or dura-
bag, which tows them back to the surface. The cur- tion exposures that appear to defy conventional
rent record depths are 214 metres for male divers wisdom with respect to limits of hypoxia? How
and 160 metres for female divers. The latter is the also do they achieve these feats without develop-
longest-standing free diving record at the present ing some of the disorders (e.g. hypoxic blackouts,
time, set by Tanya Streeter in 2002. barotrauma, decompression sickness, nitrogen
The absolute limit of these hazardous ‘experi- narcosis, O2 toxicity or high-pressure neurologi-
ments’ remains unknown, but it seems likely that cal syndrome) that are the subjects of subsequent
depth record increments will become smaller and chapters in this book?
smaller as immutable physiological barriers are Obvious anatomical adaptations include a
approached. Death may be precipitated at depth streamlined shape, low-friction body surface
by pulmonary haemorrhage, pulmonary oedema (skin or fur) and the development of flippers or
or cardiac dysrhythmias. Cerebral hypoxia is an fins. Dolphins can reach speeds of 20 knots with
invariable development during the latter stages of remarkably low energy consumption. A ­dorsal
ascent. Quite often these divers require rescue by blowhole in whales and dolphins also aids
standby divers because they become unconscious energy efficient respiration. Of more interest to
as a result of rapidly developing hypoxia as they the diving physician and physiologist are the
approach the surface. mechanisms to cope with prolonged apnoea.
Records are also held for static apnoea, The adaptations that allow diving animals to
which is a motionless, energy-conserving head achieve long periods underwater are both physi-
immersion exposure. The current records are a ological and biochemical.
mind-boggling 11 minutes 35 seconds for male
participants and 9 minutes 2 seconds for female Oxygen stores
participants.
Underwater breath-hold horizontal distances All diving mammals have an increased total body
(dynamic apnoea with fins) of 281 metres (male O2 store. The relative contribution of the lungs,
34 Free diving

blood and muscles storage areas depends on the supplied preferentially to vital organs during the
diving pattern of the animal. period of a dive.
Deep diving mammals do not dive at full lung The term diving response refers to a sequence
capacity and may exhibit reduced lung perfusion of physiological events, including apnoea, brady-
during dives for reasons discussed later, so the bulk cardia and redistribution of cardiac output, which
of O2 is stored in blood and muscle. Such animals are under the control of multiple reflexes. O2 con-
have increased blood volume (~15 per cent of body servation is thus partly accomplished by selective
mass versus ~5 to 7 per cent for humans), and the redistribution of circulating blood. Blood may be
blood has a higher haemoglobin concentration. preferentially distributed to swimming rather than
About 70 per cent of the total O2 store is found in non-swimming muscles. Studies indicate that pin-
the blood. They also have a markedly increased niped skeletal muscles have an enhanced oxidative
myoglobin concentration (5 to 12 times that found capacity to maintain aerobic metabolism under
in a human), especially in the swim muscles, and the relatively hypoxic conditions associated with
this myoglobin increase is proportional to the diving and that these adaptations are more pro-
diving capacity of the animal. Myoglobin carries nounced in swimming than in non-swimming
approximately 25 per cent of the total O2 sore. Only muscles. Other tissues that are most critical for
a tiny proportion (~5 per cent) is found in the lungs survival (e.g. retina, brain, spinal cord, adrenal
(versus ~25 per cent in humans). glands and, in pregnant seals, the placenta) are
An intriguing and controversial mechanism for also selectively perfused. The seal essentially shuts
augmenting O2 storage and delivery during a dive off the flow of blood to non-essential tissues and
is the pre-dive sequestration of oxygenated red organs, such as the kidneys, until it resurfaces.
cells in the spleen followed by the release of these Rapid onset of bradycardia (to as low as 10 per
cells by splenic contracture during a dive. The time cent of baseline rate) at the start of a dive may be
course of release into the systemic circulation may seen in diving species. This reduces cardiac work
be further regulated by a valve-like sphincter in the and O2 consumption. A substantial reduction in
vena cava. The fact that this occurs is not disputed, cardiac output has been shown in Weddell seals.
but its role in marine mammal diving adaptation is Because stroke volume falls by only about 30 per
uncertain. It has been noted that re-sequestration cent, the predominant effector of this reduction is
after release on one dive typically takes far longer the bradycardia.
than the typical surface interval between subse- Arterial blood pressure is reasonably well pre-
quent dives during a dive series. Thus, any benefit served despite this reduction in cardiac output,
may be restricted to the initial dive. It is possible and this is important to maintain perfusion of
that this adaptation is more important for keeping vital organs. Maintenance of arterial pressure is
blood haematocrit (and viscosity) at optimal levels facilitated by the stretching of the elastic walls of
when the animal is not diving than for improving large arteries during systole and their recoil dur-
oxygenation during dives. ing diastole. This function is augmented in many
species of marine mammals by a bulbous enlarge-
Oxygen consumption and ment of the root of the aorta, the aortic bulb. The
the diving response aortic bulb approximately doubles the diameter
of the ascending aorta in harbour and Weddell
The increases in blood volume, haemoglobin and seals, thus providing an elastic capacitance for
myoglobin described earlier all contribute to the maintaining pressure and flow into the constricted
seal’s impressive O2 supply, but O2 still needs to be arterial tree during the long diastolic intervals
conserved. Indeed, it can be readily calculated that characteristic of diving. The entire human aorta
if the submerged seal continued to metabolize at contains less volume than the aortic bulb alone in
the same rate as before diving, its O2 stores would seals of a similar body weight. The increase in left
not be sufficient during long dives. Not surpris- ventricular afterload that would be expected as a
ingly, these animals exhibit multiple strategies consequence of elevated peripheral resistance and
aimed at conserving O2 and ensuring that it is decreased large artery compliance is reduced by
 Further reading 35

this unique anatomy. The net result is a diminished help the animal avoid pulmonary barotrauma of
peak ­systolic pressure, which reduces cardiac work descent. Quarantining of pulmonary gas from
and O2 consumption while at the same time main- perfusing blood minimizes accumulation of nitro-
taining stroke volume. gen (decompression sickness), which may occur
The electrocardiogram of the diving animal in repetitive diving. It likely also reduces nitrogen
shows some progressive changes during pro- narcosis.
longed apnoeic dives. In addition to bradycardia, Deep diving mammals do not dive on a full
these changes may include the gradual diminution lung volume. As well as limiting nitrogen uptake,
or even abolition of the P wave. Cardiac rhythm this means that the animal is not exposed to O2
is then apparently set independently of the sino- toxicity because the partial pressures never reach
atrial node by a ventricular pacemaker site. Other dangerous levels.
cardiac dysrhythmias occasionally appear. How the elephant seal and sperm whale avoid
the high-pressure neurological syndrome during
Anaerobic metabolism their impressive diving feats is not yet understood.

With prolonged dives certain tissues switch to

anaerobic metabolism, which produces lactic acid Hypothermia
as a by-product. There is an increased tolerance to A thick layer of blubber and a relatively low ­surface
lactic acid in the muscles through increased buff- area to reduce heat loss maintain core temperature.
ering capacity. High levels of lactic acid, however, A reduction of blood flow to the skin increases
lower the pH of the blood and can lead to acido- insulation of the fat layer and allows surface cool-
sis, causing a weakening of the heart’s ability to ing, which is not transmitted to the internal core.
contract. Acidosis is avoided by confining anaero- Well-developed countercurrent heat exchange sys-
bic metabolism to the skeletal muscles and other tems also aid in conserving heat by cooling arte-
tissues isolated from the blood supply. When the rial blood and heating venous blood as it returns
animals resurface, these tissues release the lactic to the core. Examples can be found in the fins and
acid into the blood for metabolism by the liver. flippers of whales and seals. Working muscles
are close to the surface and have little fat insula-
Diving technique tion. Also, many animals, when not diving, have a
raised metabolic rate to produce heat.
Modified diving behaviour to limit muscle activity
and thus O2 consumption has been demonstrated
in Weddell seals. Prolonged downward gliding, FURTHER READING
with minimal muscular effort, as a result of reduc-
ing buoyancy with lung compression at depth can Kooyman GL, Ponganis PJ. The physiological
result in up to a 60 per cent reduction in energy basis of diving to depth: birds and mammals.
costs. Gliding is used during dives exceeding Annual Review of Physiology 1998;60:19–32.
18 metres in depth and occupies approximately Lindholm P, Lundgren CEG. The physiology
75 per cent of the descent. and pathophysiology of human breath
hold diving. Journal of Applied Physiology
Pressure changes 2009;106:284–292.
Thornton SJ, Hochoachka PW. Oxygen and
Structural adaptations to accommodate thoracic the diving seal. Undersea and Hyperbaric
compression during deep dives include a flexible Medicine 2004;31:81–95.
rib cage, stiffened alveolar ducts and attachments
of the diaphragm such as to permit some shifting of This chapter was reviewed for this fifth edition by
abdominal contents into the thorax. These changes Simon Mitchell.
 4
Diving equipment

Introduction 37 Safety and protective equipment 42

Equipment for recreational diving 37 Dive boats 45
Snorkeling/breath-hold diving equipment 37 Professional or technical diving equipment 46
Self-contained underwater breathing Breathing systems 46
apparatus – scuba 39 Chambers, habitats and underwater vehicles 51
Surface-supply breathing apparatus 41 Further reading 52

INTRODUCTION comfort but also some protection from box jelly-

fish and other stings.
The first part of this chapter deals with the equip-
ment used by most recreational divers. The more MASK
complex and unusual types of diving equipment A mask is needed to give the diver adequate vision
that are used by technical, commercial or military underwater. The mask usually covers the eyes and
diving operations are dealt with in the second part nose. Traditionally, masks were made from rubber,
of the chapter. Attention is paid to the problems although now most are made from silicone. The
the equipment can cause, particularly for the stu- mask seals by pressing on the cheeks, forehead and
dent or novice. This is of importance in under- under the nose with a soft silicone edge to prevent
standing the medical problems that are related to entry of water. Swimming goggles, which do not
diving equipment. It may also help the reader to cover the nose, are not suitable for diving. The nose
understand the stresses experienced by the novice must be enclosed in the mask so that the diver can
diver. exhale into it to allow equalization of the pressure
between the face and mask with the water environ-
EQUIPMENT FOR RECREATIONAL ment. It should be possible to block the nostrils with-
DIVING out disturbing the mask seal to enable the wearer to
perform a Valsalva manoeuvre. Full-face masks that
Snorkeling/breath-hold diving cover the mouth as well as the eyes and nose, or hel-
equipment mets that cover the entire head, are more commonly
used by professional divers and are considered in the
The simplest assembly of diving equipment is that section on professional ­diving equipment.
used by snorkelers – a mask, snorkel and a pair of The faceplate of the mask should be made from
fins. In colder climates, a wetsuit may be added for hardened glass. A diver with visual problems can
thermal insulation and a weight belt to compen- choose from a selection of corrective lenses that
sate for the buoyancy of the suit. In tropical waters, are commercially available. These are designed
a ‘stinger suit’ provides not only a little thermal to attach directly to certain masks. Alternatively,

37
38 Diving equipment

prescription lenses can be ground and glued to a difficulties of a diver who may be struggling to
variety of masks. Ocular damage can occur if hard cope with waves breaking over him or her (and
corneal lenses are used for diving (see Chapter 42). into the snorkel) and a current that may force the
Certain contact lenses may be lost if the mask diver to swim hard. There have also been anecdotal
floods and the diver fails to, or is unable to, take reports of divers inhaling foreign bodies that have
preventive action. Some people with allergy prob- previously lodged in the snorkel.
lems react to the rubber of the mask, although this
is rarely an issue with silicone. FINS
All masks cause a restriction in vision. With Fins (or flippers) are mechanical extensions of
most masks, the diver can see about one third of the feet. Fins allow the diver to swim faster and
his or her normal visual field. The restriction is more efficiently, and they free the diver’s arms
most marked when the diver tries to look down for other tasks. The fins are normally secured to
toward the feet. This restriction can be a danger if the feet by straps or are moulded to fit the feet.
the diver becomes entangled. However, there are Various attempts have been made to develop fins
some masks available with a tilted lens to provide a that give greater thrust with special shapes, valves,
better downward field of vision. controlled flex, springs and materials, all compet-
The more nervous beginner may find the visual ing for the diver’s dollar. Some of these fins can
restriction worrying and may possibly fear that improve the thrust, but the wearer needs to become
there is a lurking predator just outside the field accustomed to them. Others have little effect.
of vision. The visual field varies with the style of Divers often get cramps, either in the foot or calf,
mask. Experimentation is also needed to find if fins are the wrong size, if the diver has poor tech-
which mask gives a good seal, to minimize water nique or if the diver has not used fins for an extended
entry. The diver needs to master a technique to period. The loss of a fin may also cause problems for
expel water from the mask. If it is not learned and a diver, especially if he or she has to a swim against
mastered, a leaking mask can become a major a current, or fails to attain appropriate orientation
problem, sometimes leading to panic. underwater or buoyancy on the surface.

SNORKEL WEIGHTS
The typical snorkel is a tube, about 40 cm long and Even without the buoyancy of a wetsuit, some div-
2 cm in diameter, with a pre-moulded or creatable ers require extra weights to submerge easily. The
U-bend near the mouth end. A mouthpiece is fitted weights are made from lead, and most are moulded
to allow the diver to grip the tube with the teeth to thread onto a belt. Some weights are designed to
and lips. The tube is positioned to pass upward near fit into pouches, either on a belt or, for scuba divers,
the wearer’s ear to enable him or her to breathe attached to a buoyancy compensator device (BCD).
through the tube while floating on the surface and Whatever weighting mechanism is used needs to
looking down. Any water in the snorkel should be be fitted with a quick-release buckle or other mech-
expelled by forceful exhalation before the diver anism to allow a diver to drop the weights quickly
inhales through the snorkel. and so aid his or her return to, or enable the diver
Many attempts have been made to ‘improve’ the to remain on, the surface. The situations in which
snorkel by lengthening it, adding valves, modify- a quick-release buckle may not be fitted (or may be
ing its shape and some other means. There is little de-activated) are those where it would be danger-
evidence of the success of most of these attempts. ous to ascend, such as in caves where there is no air
All snorkels impose a restriction to breathing. space above the water.
A typical snorkel restricts the maximum breath- In some circumstances, it is necessary for a diver
ing capacity to about 70 per cent of normal. The to ditch the weight belt to reach, or remain on, the
­volume of the snorkel also increases the diver’s surface in an emergency. Such situations include
anatomical dead space. Because of this, increasing an emergency in which the scuba diver cannot
the diameter substantially to reduce the resistance inflate the BCD, for example, if the diver is out of
is not a viable option. These problems add to the breathing gas. Unfortunately, divers often fail to
 Equipment for recreational diving 39

release the belt if they are in difficulty. The reason underwater breathing apparatus (scuba), the tap
for this omission is not clear, but it is likely often is replaced by a two-stage valve system. The flow
the result of stress or panic. Adequate initial train- of gas to the diver is triggered by the diver’s inspi-
ing and practice help to reinforce the skill so that it ratory effort and is closed by expiration or cessa-
will become more automatic when required. It also tion of inspiration.
needs to be reinforced periodically. Unfortunately, Figure 4.1 and Figure 4.2 (a) and (b) show the
much of the current training fails to focus ade- operating principles of a simple regulator and
quately on this important emergency drill. demand valve system. The air is stored in a cyl-
An alternative drill of taking the belt off and inder at a maximum pressure that is determined
holding it in one hand (preferably away from the by the design of the cylinder. For most cylinders
body) is useful in some situations in which the this pressure, called the working pressure, is 160 to
diver is likely to become unconscious and inflating 300 bar (2300 to 4350 psi).
the BCD is not an option or may not be sufficient The first stage of the valve system (see Figure 4.1)
(e.g. when deep). In the event of unconsciousness, reduces the pressure from cylinder pressure to the
the belt will hopefully fall away, causing the diver equivalent of about 10 ATA greater than the pres-
to rise to the surface. Holding the belt away from sure surrounding the diver, and it regulates its out-
the body should reduce the chance of entangle- let pressure at this value. The valve is held open by
ment with the diver if it is dropped. the force of a spring until the pressure above the first
stage piston builds up and forces the valve seal down
on the seat, thus shutting off the gas. The first-stage
In many fatal diving accidents the diver did
not release his or her weights. Unbalanced piston
(open) high-pressure
seat Spring
This basic free diving equipment is adequate Piston
Water entry
for diving in shallow, relatively warm water.
Experience with this gear is excellent training
for a potential scuba diver. The diver can gain
the basic skills without the extra complications
caused by scuba gear. It allows a more realistic
self-­assessment of the desire to scuba dive and
the subsequent rewards. With the confidence
gained in snorkeling and breath-hold diving and
the associated aquatic skills, the diver is also less
likely to become as dependent on the breath-
ing apparatus. In cold climates, a snorkel diver
needs a suit to keep warm. Suits are discussed in High pressure air ‘O’ ring
To demand
(at cylinder
Chapter 27. valve (at about
pressure)
10 atmospheres
above water
Self-contained underwater breathing pressure)
apparatus – scuba
Figure 4.1 First stage reducer valve: the gas
The simplest form of breathing apparatus con- escapes from the cylinder until the pressure
above the piston increases to a level where the
sisted of a gas source and a tap that the diver
force on the piston can compress the spring,
turned on to obtain each breath of air. This sys- pushing the first stage valve seat down and shut-
tem was in use until the 1930s, but much of the ting the gas flow off. The valve opens again when
diver’s time and concentration were taken up in the pressure above the piston (and in the hose
operating the tap. In the most common breath- to the second stage valve) falls. This is normally
ing apparatus, the Aqualung or self-contained because the diver has taken another breath.
40 Diving equipment

Purge button
Diaphragm
Water chamber

High-pressure
air valve
(open)
Exhaust valve
(closed)

High-pressure
air supply Valve lever Mouthpiece
(a)

High-pressure
air valve
(closed)
Exhaust valve
(open)

(b)

Figure 4.2 SCUBA demand valve (a) during inspiration and (b) exhalation. The arrows indicate air flow.
During inspiration the diver decreases the pressure in the mouthpiece. This causes the diaphragm to
curve in and tilt the air supply valve open. At the end of inspiration air continues to flow until the pres-
sure in the mouthpiece equals the pressure in the water chamber, at this stage the diaphragm will return
to the position shown in 4.2(b), and the air supply valve shuts. During exhalation the pressure in the
mouthpiece is greater than that in the surrounding water. This pressure difference forces the exhaust
valve open and allows exhaled air to escape. The purge button is used to trigger a flow of gas from the
supply without the need to inhale from the regulator.

valve opens and closes as gas is drawn from the Expired gas passes out of the second stage
­system by the diver. In some regulators, the water through an exhaust valve. In the demand valve,
can enter the water chamber and helps the spring gas flow increases with respiratory effort because
to hold the valve open. In others, the ambient water the valve opens more, allowing the diver to breathe
pressure is transmitted indirectly. This adjust- normally. The purge button allows the diver to
ment of the s­upply pressure with water pressure is open the inlet valve to force any water out of the
designed to prevent the flow decreasing as the diver regulator. The diver may need to do this if he or she
descends. takes the regulator from the mouth while under-
When the diver inhales, he or she reduces the water or if the seal around the mouthpiece is poor.
pressure in the mouthpiece chamber, or second-
stage valve. As the diver does so, the diaphragm The scuba regulator is designed to provide
curves inward and depresses the lever (see the diver with a gas supply matched to his or
Figure 4.2 (a)). The inlet valve opens and remains her respiratory needs.
open until inhalation ceases. At this stage, the dia-
phragm moves back into the position shown in
Figure 4.2 (b). The second-stage valve is usually Most divers have little difficulty using scuba.
called the demand valve. However, when they first don it, the weight and
 Equipment for recreational diving 41

bulk will make them awkward, and may aggravate that he or she has a cylinder or cylinders with
back problems. In the water, the buoyancy of the adequate gas supply for the planned dive, and an
set offsets its weight. additional reserve.
The diver’s lips should be sealed around the A traditional and almost obsolete system to
mouthpiece to prevent the entry of water. Water prevent divers from running out of air is a reserve
can enter through a hole in the mouthpiece if the valve. In operation it resembles a boiler safety
mouthpiece is poorly attached or through the dia- valve; the air escapes to the diver until the cylinder
phragm or exhaust valve if either is faulty. A leak pressure falls to the level at which the reserve valve
can generate an aerosol if the water reaches the seats. The remainder of the air can be released by
inlet valve of the second-stage valve. The aerosol pulling a lever that opens the reserve valve. One
can cause distress to the diver and may some- problem with this is that the valve lever may be
times cause a syndrome called salt water aspira- inadvertently put into the ‘on’ position, causing
tion ­syndrome, or it may trigger other medical the diver to use the reserve of gas without being
conditions such as asthma or possibly a cardiac aware of this. Another common problem is valve
dysrhythmia. failure.
Another problem associated with demand
valves is that they may cause pain in the temporo- Surface-supply breathing apparatus
mandibular joint. This condition is considered in
Chapter 42. A diver can also use a demand valve with air
In very cold water, the first stage of the regulator ­supplied by a hose from the surface. This equip-
may ‘freeze up’. This occurs because the air cools ment, surface-supply breathing apparatus (SSBA),
as it passes through the first stage and can ice up restricts the diver’s range and depth to the length of
with the piston frozen in the open position. The the air supply hose. Its advantages are that the diver
problem can be reduced by using a first stage that is freed from the cumbersome air cylinders and the
is designed for operation in cold water. air supply can be as large as needed, instead of being
Because the first stage regulates the pressure to restricted by the diver’s carrying capacity and need
the second stage, the inspiratory effort required for mobility. The air for SSBA may be stored in large
to cause a flow does not vary until the cylinder is tanks or compressed as required. The use of a com-
almost empty. Then the pressure in the hose to the pressor, often called a ‘hookah’ system, is economi-
second stage falls and the flow decreases. The div- cally attractive because the air is compressed to a
er’s first warning that the cylinder is almost empty lower pressure than that required for storage tanks.
is increased resistance on inhalation. However, However, the compressor needs to be reliable and
this warning may be minimal or absent with mod- there needs to be an observer to monitor the com-
ern regulators. pressor during operation.
Most divers have a console that includes a pres- Two modified forms of SSBA have found sup-
sure gauge connected to the cylinder by a hose. port in some circles. In one, a small motor and air
Some modern systems transmit the cylinder pres- compressor are supported on a float on the surface.
sure via radiofrequency signals rather than via a This apparatus supplies air to one or two divers.
hose. The pressure gauge provides the diver with a In the other, the divers tow a float that supports
measure of the remaining air supply. The contents an air cylinder. An advantage of these systems is
of the cylinder are proportional to the pressure, that, if the hoses are short, the divers are unable to
so the gauge is often called the ‘contents gauge’. reach the depth needed to develop decompression
Divers tend to say they have 50 bar left, rather than sickness (DCS). A significant problem is that the
the volume this represents. A major problem is that user has no indication of when the gas supply will
a diver who is entranced by the scenery, concen- fail. Therefore, it is prudent for the diver to carry a
trating on a task or distracted may run out of air small bail-out cylinder and regulator. Also, some
because he or she forgets to check the gauge. An novice users may forget that they are still exposed
audible low-air warning is incorporated into some to the other hazards of scuba diving, such as pul-
systems and is valuable. A diver needs to ensure monary barotrauma.
42 Diving equipment

In some resort areas, these devices are hired by breaths for ascent. For this reason, these devices
novices who have had no training and who may be are not commonly used and are not sufficient for
medically unfit to dive. Such use should be con- deep dives or dives requiring decompression. It is
trolled and monitored in a similar manner to nor- important that a redundant supply provides ade-
mal scuba instruction and equipment hires. quate gas for a relatively safe ascent.
It is also sometimes possible for a diver to
Safety and protective equipment breathe air from the BCD for a short period of
ascent. However, this has potential hazards,
The best safety measures available to a diver are including aspiration of water, infection and buoy-
adequate health and fitness, proper training, ancy control problems. A BCD with an indepen-
appropriate and functional equipment and com- dent air supply is available but not commonly used.
mon sense. Almost all accidents are preventable,
and the authors do not ascribe the popularly held THERMAL PROTECTION
belief that these accidents are attributable to an ‘act Thermal protection is needed in cold water or on
of God’. Many accidents involve human, often pre- prolonged dives to minimize the risk of hypother-
dictable and thus correctable, mistakes. This point mia. This protection is normally provided by insu-
is developed in Chapter 46, in which deaths and lated clothing, which reduces heat loss. The most
accidents are considered. Several items of equip- common protection is a wetsuit, made from
ment that reduce the hazards of diving, or assist ­air-foamed Neoprene rubber. The water that leaks
with coping with them, are discussed here. into spaces between the suit and the diver soon
warms to skin temperature. Foamed Neoprene has
EMERGENCY AIR SUPPLIES insulation properties similar to those of woollen
Emergency air supplies can take a variety of felt. Its effectiveness is reduced by loss of heat with
forms. In the early days it was common to rely on water movement and increasing depth. Pressure
buddy-breathing, a procedure in which two divers decreases insulation by reducing the size of the air
shared an air supply in the event one of them had cells in the foam. At 30 metres of depth, the insula-
an air supply failure. Both anecdote and analysis of tion of a wetsuit is about one third of that on the
diving accident statistics showed that this proce- surface (see Figure 27.1). The compression of the
dure often did not work in an emergency. The use of gas in the foam also means that the diver’s buoy-
a second regulator attached to the scuba set, often ancy decreases as he or she goes deeper. The diver
called an octopus rig, has now become standard can compensate for this by wearing a BCD. If the
fare, and its introduction and widespread use have diver does not, he or she needs to limit the weights,
helped to avoid many serious diving accidents. but this will mean that the diver is too buoyant
However, neither buddy-breathing nor an octopus when closer to the surface. The buoyancy and insu-
rig will be of use if the diver with gas is not avail- lation of a wetsuit decrease with repeated use.
able or is unwilling to cooperate. For this reason, Another other common form of thermal pro-
a second source of air (redundant supply) that is tection is the drysuit. This is watertight and has
available to each diver without external assistance seals round the head, feet and hand openings.
is now favoured. For cave divers this may essen- There is an opening with a waterproof seal to allow
tially be a second scuba set. For technical divers the diver to get into the suit. The drysuit allows the
with substantial mandatory decompression obliga- diver to wear an insulating layer of warm clothes.
tions, a redundant gas supply is also essential, and A gas supply and exhaust valve are needed to allow
they often carry what is known as a stage cylinder. the diver to compensate for the effect of pressure
For most divers, who have relatively ready access changes on the gas in the suit. The gas can be sup-
to the surface, a smaller cylinder with an indepen- plied from the scuba cylinder or a separate supply.
dent regulator can be used. One commercially The diver needs training in the operation of a
available device, known as Spare Air (Submersible drysuit or he or she may lose control of buoyancy
Systems, Inc.), is carried by some divers. However, by excessive addition of air into the suit. This can
the air supply is very small, enabling only a few lead to an uncontrolled ascent, sometimes inverted,
 Equipment for recreational diving 43

when the excess of gas expands, s­ peeding the ascent. In the past, BCDs were also designed to float
If the diver tries to swim downward, or otherwise an unconscious diver face-up on the surface.
becomes inverted in the water, the excess gas may However, with the current designs this useful ben-
accumulate around the legs, from where it cannot efit has been largely foregone.
be vented through the exhaust valve. The excess gas
can also expand the feet of the suit and cause the DEPTH GAUGES
diver’s fins to pop off. The diver can find himself or A depth gauge, timer and a means of calculat-
herself floating on the surface with the suit grossly ing decompression are needed if an unsupervised
overinflated, a most undignified and potentially diver is operating in a depth or time zone where
dangerous posture. decompression stops may be needed. Electronic,
Heat can also be supplied to a diver to help mechanical and capillary gauges have been used as
him or her keep warm. The commonly used sys- depth gauges by divers. Capillary gauges, although
tems include hot water pumped down to the diver now rarely used, measure pressure by the reduc-
through hoses. Various chemical and electrical tion in volume of a gas bubble in a graduated capil-
heaters are also available. External heat supplies lary tube and were useful only at shallower depths.
are more often used by commercial divers. Most gauges record the maximum depth reached
Semi-drysuits are essentially wetsuits with by the diver during the dive, an important feature
enhanced seals at the neck, hands, feet and zip- for tracking decompression status if using tables.
pers. These seals help to reduce the amount of water Although the modern digital gauges are relatively
entering and leaving the suit and so reduce heat loss. accurate, there can occasionally be problems (as
They are not as effective as drysuits in keeping the there often were with mechanical gauges), and
diver warm, but they can provide thermal protec- the need to check the accuracy of gauges is often
tion similar to that of a significantly thicker wetsuit overlooked. Faulty gauges have caused divers to
and so increase the level of comfort for the wearer, develop DCS.
as well as reducing the amount of weight carried.
DIVE COMPUTERS
BUOYANCY COMPENSATOR DEVICES Dive computers use a depth (pressure) sensor, timer,
BCDs consist of an inflatable vest (or back-mounted microprocessor, display and various other features.
bags [wings]) worn by the diver and attached to a They are encoded with a decompression algo-
gas supply from the regulator. The BCD allows the rithm – a set of mathematical equations designed
diver to adjust buoyancy underwater or helps bring to simulate the uptake and elimination of inert gas
the diver to the surface and/or support him or her within a diver’s body. By sampling the depth and
there. The ability to change buoyancy allows the recalculating every few seconds, these computers
diver to hover in the water and adjust for any factor enable dive times well beyond those permitted by
that causes density to increase (e.g. wetsuit com- tables on most dives, especially on multi-level and
pression, picking up a heavy object on the bottom). repetitive dives. Some of the more sophisticated
Most BCDs can be inflated via a hose from the models take into account ambient temperature
regulator. Some have a small separate air bottle and/or gas consumption, and some even measure
that can also be used as an emergency air sup- heart rate (Figure 4.3). However, they can still only
ply, although these are now rare. Several valves to ‘guesstimate’ a diver’s actual saturation, and DCS
release gas are fitted so the diver can reduce buoy- remains a significant concern with computer users.
ancy by venting gas from the compensator. In fact, most people diagnosed with DCS these
Divers can lose control of their buoyancy days have been diving within the limits indicated
while ascending. As the diver starts to ascend, the as theoretically safe by their devices. Users are well
expanding gas in the BCD increases its lift and advised to use more conservative limits than the
in turn increases the rate of ascent. Such a rapid, ‘factory settings’. Some models enable the user to
uncontrolled ascent can lead to a variety of div- adjust the computer to more conservative modes.
ing medical problems including pulmonary baro- Despite this, dive computers have revolu-
trauma and DCS. tionized diving because of their flexibility and
44 Diving equipment

Figure 4.3 Two of the more sophisticated current model recreational dive computers (a) Galileo Sol
(Scubapro, USA); and (b) Vytec (Suunto, Finland).

the vastly increased underwater times enabled. Underwater audible signalling devices are com-
Possibly their greatest contribution to diving mercially available and are useful in such circum-
safety is the incorporation of ascent rate warn- stances. These are generally driven by breathing
ings to caution the wearer when he or she ascends gas and are attached to the low-pressure hose in
faster than the recommended rate, which is usu- series with the BCD inflator.
ally substantially slower than traditional rates
used with most decompression tables. DIVER LOCATION DEVICES
Sometimes divers can be difficult to sight on the
CONTENTS GAUGE surface after a dive because of the sea conditions
The role of this gauge is discussed earlier. The con- and/or divers surfacing distant from the boat, often
tents gauge indicates the pressure and, by extrapo- swept away by current. This can lead to stranding
lation, the amount of gas remaining in the supply of divers at sea for extended periods, with some lost
cylinder. forever.
Various devices are available to try to prevent
COMMUNICATION this problem. Commonly used location devices
Because of the risks in diving, it is generally con- include horns, whistles, mirrors, safety sausages
sidered foolhardy to dive without some method of and other surface marker buoys (SMBs). There
summoning assistance. Most commercial divers are also commercially available electronic diver
do this with an underwater telephone or signal location devices. Some consist of a receiver and
line. Divers who do not want the encumbrance of a number of transmitters. The receiver is located
a link to the surface can dive in pairs, commonly on the boat (or can be elsewhere), and individual
called a ‘buddy pair’. Each diver has the duty to aid transmitters are issued to divers. This system
the other if one gets into difficulty. The common enables a charter operator to track its divers con-
problem in the use of the buddy system is attract- tinuously. Suitable electronic position-indicating
ing the attention of the buddy if he or she is looking radio beacons (EPIRBs) have been developed or
elsewhere or if separation has occurred, whether adapted for use by divers, and these are becom-
intentional or otherwise. ing more frequently used. One such device is
 Equipment for recreational diving 45

A lead line is often used to assist the diver on

the surface. It leads from the stern of the boat
to the anchor chain. It allows the diver, who has
entered the water at the stern of the boat, to reach
the anchor when the current is too strong to
swim to it.
When diving in caves or some wrecks, a ‘guide
line’ should be use. This is a continuous line to
the entrance is needed so that it can be followed if
the divers become disorientated or when visibility
is lost because of torch failure or formation of an
opaque cloud by disturbed silt. Each diver should
be within arms reach of the main line.

Dive boats
Boats used for diving range from kayaks and
canoes to large, specialized vessels that support
deep and saturation diving. The facilities required
depend on the nature of the diving, but there are
minimum requirements. In some conditions, a
second safety boat or tender may be needed. Divers
Figure 4.4 Nautilus Lifeline, BC, Canada. may need to be picked up after drifting away from
the main vessel.
shown in Figure 4.4. They can be especially helpful Propellor guards, or a safe propulsion sys-
when diving in remote locations. However, rescue tem such as a water jet, is desirable if there is any
depends on adequate monitoring of distress sig- chance that the engine will be engaged during div-
nals, as well as the willingness and ability of local ing operations.
authorities to perform a search and rescue. This A diving platform or ladder is needed on most
can be a problem in some developing countries. boats to facilitate the diver’s return from the water.
Consideration should be given to the recovery of
LINES an unconscious or incapacitated diver, which is
A ‘mermaid’ line is attached to the stern of the boat ideally done with the diver positioned horizontally.
and extends down-current. It aids recovery of div- This can be very difficult with both large and small
ers when they surface downstream. (Some call this boats, and an appropriate system should be estab-
the ‘Jesus line’ as it saves sinners – i.e. divers who lished and practised. Recovery into an inflatable
have erred and surfaced down-current from the craft is often an easier alternative because the diver
dive boat!) This is not needed if a lifeline or pickup can be dragged, rather than lifted, into the boat.
boat is being used, or if the current is insignificant. Also, the softer air-filled hull is less likely than a
A shot line is a weighted line that hangs down rigid hull to injure a diver.
from the dive boat or from a buoy. It is often used Diving flags, lights or other signals as required
to mark the dive site and as a descent and ascent by the local maritime regulations should be avail-
line. It can also be the centre for a circular pat- able. These are designed to warn boat operators to
tern search. It can be marked with depth mark- slow down or keep clear. In some places they can
ers that can be used to show the decompression offer legal, if not physical, protection from the
stop depths. The diver can hold onto the line at antics of other craft. Unfortunately, in many places
the depth mark. A lazy shot line is a weighted the flag is not recognized or is ignored, and in most
line that does not reach the bottom and is used for areas ‘boat propeller attacks’ cause more deaths
decompression stops. than shark attacks.
46 Diving equipment

The first aid kit and emergency medical equip- with a flow of hot water may also be used to warm
ment (see Chapter 48) should be chosen depending the diver. It is normal for the diver to have an alter-
on local hazards and the distance from assistance. native supply of breathing gas in a cylinder on his
or her back. This supplies the diver with breathing
PROFESSIONAL OR TECHNICAL gas if the main supply should fail.
DIVING EQUIPMENT Free-flow systems were used in the first com-
mercial air diving apparatus. The diver was sup-
This section deals with the more specialized equip- plied with a continuous flow of air that was pumped
ment used by professional and military divers, as down a hose by assistants turning a hand-operated
well as some recreational technical divers. Many of pump. The hand-operated pumps have long gone,
the military diver’s tasks, and some of those of the but the same principle is still in use. In the most
professional diver, involve comparatively shallow common system, called standard rig, the diver’s
depths. Such tasks could be conducted with scuba head is in a rigid helmet, joined onto a flexible suit
gear of the type described earlier. Equipment fitted that covers the body. The diver can control buoy-
with communication devices allows the diver to ancy by controlling the amount of air in the suit.
confer with the surface support. Communication The main problem with the system is that the flow
devices operate better in air, so they are commonly of fresh breathing gas must be sufficient to flush
fitted into a helmet or full-face mask. In these carbon dioxide from the helmet. The flow required
devices, the airflow may either be continuous or on to do this is about 50 litres/minute (lpm), measured
demand. at the operating depth; this is well in excess of that
More specialized equipment is used for some needed with a demand system.
military diving where an element of stealth is The other problem associated with free-flow
required. For these tasks, an oxygen rebreath- systems and the high gas flow is the noise this
ing system that can be operated with no telltale generates. In the early days, the diver was also
bubbles may be used. In dealing with explosive exposed to the risk of a particularly unpleasant
mines, stealth is again required to avoid activating form of barotrauma. If the pump or air supply
the noise- or magnetically triggered circuits. If the hose breaks, the pressure of the water tends to
mine may be too deep for an oxygen set, a rebreath- squeeze the diver’s soft tissues up into the helmet.
ing system with an oxygen-nitrogen mixture may This is prevented by fitting a one-way valve that
be used. stops flow back up the hose. For deep dives, where
For even deeper tasks, for which oxygen-helium oxygen-helium mixtures are used, the cost of gas
mixtures are used, some method of reducing the becomes excessive. A method of reducing the gas
gas loss gives cost and logistical savings. This can consumed may be fitted. For example, some units
be achieved by the diver’s using a rebreathing sys- incorporate a canister of carbon dioxide absorbent
tem or returning the exhaled gas to the surface for to purify the gas. The gas flow round the circuit is
reprocessing. generated by a Venturi system that does away with
the need for valves to control gas flow. The rig is
Breathing systems converted into a rebreathing system, which has a
separate set of problems that are considered in a
OPEN-CIRCUIT BREATHING SYSTEMS later section.
For most tasks, the professional diver is working in Demand systems were developed to gain a
a small area for long periods. Because of this, he or reduction in gas consumption compared with
she does not need the mobility of the scuba diver. free-flow systems. They also enable the diver to
The breathing gas normally comes from the surface talk underwater. Several types of equipment are in
in a hose, either supplied from storage cylinders or common use. One type uses a full-face mask that
compressed as needed by a motor-driven compres- seals round the forehead, cheeks and under the
sor. The cable for the communication system and chin. The back of the diver’s head may be exposed
a hose connected to a depth measuring system are to the water or covered with a wetsuit hood that is
often bound to the gas supply hose. Another hose joined onto the face mask.
 Professional or technical diving equipment 47

Another type is fitted in a full helmet. An oro- is consumed by the diver back into the circuit.
nasal mask in the helmet reduces rebreathing of This is called a ‘rebreather’, and such breathing
exhaled air. The helmets are often less comfortable apparatus can offer substantial reductions in gas
than the face masks, but they give better thermal consumption over open-circuit systems. The fol-
and impact protection. lowing is a summary of some advantages and
These helmets may also be used at greater disadvantages of rebreather systems, which are
depths, where helium mixtures are used. A return expanded upon in the following paragraphs:
hose may be used to allow collection of the exhaled
gas at the surface for reprocessing. Advantages
When compared with a demand valve held in ●● Vastly reduced gas consumption, especially
the mouth, all the systems mentioned earlier have during deep diving.
the major advantage of reducing the chance of the ●● Reduction of cold stress and dehydration by
diver’s drowning. This is important if the diver the breathing of warm, humidified gas.
becomes unconscious and/or has a convulsion ●● Lack of bubbles good for photography, covert
while breathing high partial pressures of oxygen operations, fragile environments such as caves.
(PO2). The increased safety and the advantages of a ●● Improved decompression efficiency because of
clear verbal communication system have led to the maintenance of ‘optimal PO2’.
adoption of helmets by most diving firms. ●● Excellent duration in relatively small unit.

Disadvantages
Sets that use a helmet and a full-face mask
●● Significant initial cost.
reduce the risk of drowning and can allow the
●● Greater complexity and vastly increased need
diver to converse with people on the surface.
for training, vigilance and maintenance.
●● Different hazards to diver, higher overall risk.

REBREATHING SYSTEMS Rebreathers fall into one of two main types –

Respiration is designed to provide our tissues with closed-circuit rebreathers (CCRs) and semi-closed-
oxygen and to eliminate carbon dioxide produced circuit rebreathers (SCRs). Although both types
by metabolism. When we breathe on the surface, recirculate all, or part, of the breathing gas, the
we consume about 25 per cent of the oxygen that main difference lies in the way that the oxygen level
we inhale with each breath. Thus, if our respira- is controlled and added into the circuit.
tory minute volume (RMV) were to be 20 lpm, we In general, SCRs are less complex but less effi-
would breathe in 4 litres of oxygen each minute, cient and have depth limitations dependent on the
of which 1 litre would be consumed and 3 litres gas selection. CCRs are the most complex but also
would be exhaled back into the surrounding atmo- the most efficient and most capable with regard to
sphere. Although this may not seem very efficient, depth and duration.
the situation becomes substantially worse when we Because of the similarity between SCR and CCR
descend on open-circuit scuba equipment. sets, their common features are discussed first, and
As the depth and pressure increase, the amount features peculiar to each type are then highlighted
of gas we inhale with each breath must also increase separately.
to compensate. Thus, at 40 metres (5 ATA), we The usual gas flow pattern found in a rebreath-
would need to breathe 100 lpm from our cylin- ing set is shown in Figure 4.5. The movement of
der to achieve the same 20 lpm surface RMV. This inhaled and exhaled gas is controlled by one-way
100 litres of air would contain about 20 litres of valves at the mouthpiece as the gas flows round the
oxygen, of which 19 litres are being exhaled into circuit. For largely historical reasons, rebreathers
the ocean unused! of UK or European origin usually have a clockwise
One solution to this inefficiency of gas con- gas flow pattern, whereas those of US origin have
sumption is to recirculate the gas, removing the an anticlockwise pattern. However, this is not uni-
carbon dioxide and adding only the oxygen that versally so.
48 Diving equipment

Mouthpiece with one-way check valves a continuous flow of oxygen into the circuit.
A manually operated method of adding oxygen to
the breathing bag is also usually fitted. This will
be needed when the diver puts the unit on, when
he or she goes deeper and the gas in the breath-
Counterlung ing bag is compressed, or when the diver needs to
increase buoyancy.
CO2
scrubber The unit can be operated as a closed system
because, unless something goes wrong, the gas in
the breathing bag will contain a high concentra-
Gas inflow tion of oxygen, diluted with nitrogen that was in the
lungs and body of the diver when he or she put the
unit on. It is standard practice to flush the counter-
Breathing hoses lung with oxygen at set intervals to ‘denitrogenate’
= Direction of gas flow before starting the dive to prevent a build-up of
diluting gases.
Figure 4.5 A stylised rebreather layout. Possible problems with these units include car-
bon dioxide toxicity if the absorbent fails, dilu-
As the diver descends, gas must be added from tion hypoxia if the oxygen is impure or the diver
a high-pressure cylinder into the breathing loop neglects to flush nitrogen from the lungs and
so that a constant volume is maintained within the c­ ounterlung and oxygen toxicity if the diver
the system. In most units, the gas is automatically de­scends too deep.
added via a regulator-type valve (automatic diluent To reduce the risk of oxygen toxicity, a depth
valve [ADV]). A manually controlled valve allows limit of about 6 to 8 metres is often imposed on
the diver to add extra gas if it is required. This the use of these units to limit the PO2 to 1.6 to 1.8
addition of gas will affect buoyancy. ATA, a range generally deemed acceptable for mili-
The counterlung acts as a gas storage bag that tary operations, although too high for recreational
expands and contracts as the diver breathes. technical diving, where a lower risk is appropriate
It ­normally incorporates a relief valve (over-­pressure and consequently a PO2 significantly lower than
valve [OPV]) that releases surplus gas into the water 1.6 ATA is usually maintained.
and prevents excess pressure building up. Venting Closed oxygen rebreathing apparatus has the
of excess gas is needed in CCR sets when the diver particular advantage that a small unit may give a
ascends and the gas in the counterlung expands. long endurance. A unit weighing less than 15 kg
In SCR sets, excess gas vents regularly through the can allow dives of more than 2 hours. The lack of
relief valve. bubbles and quietness of this unit are also impor-
The carbon dioxide absorbent is usually a mix- tant in some specialized roles such as clandestine
ture of calcium and sodium hydroxides. These operations.
chemicals react with carbon dioxide to form car-
bonates and water, as shown: Rebreathing units are quieter and have a
greater endurance than scuba units. The
M(OH)2 + CO2 → MCO3 + H2O extra hazards and costs involved restrict
their use and demand significant extra
Closed-circuit oxygen systems are the sim-
­training, maintenance and vigilance.
plest CCR sets. The counterlung is filled with
oxygen from the cylinder. As oxygen is con-
sumed, the volume of the bag decreases. In some In closed-circuit mixed gas systems, oxygen
units, a trigger mechanism that operates like a and a diluting gas are fed into the breathing loop
demand valve releases more gas into the bag. In at rates required to keep the PO2 within safe limits
other units, there is a mechanism that releases and to provide an adequate volume of the mixture.
 Professional or technical diving equipment 49

to track the PO2 in the loop. This allows for the

­comparison of the outputs of the sensors because
PO2 display they are relatively fragile and prone to failure, as well
as having a limited life (usually ~18 months).
Microprocessor If the volume of gas in the bag falls, this trig-
Solenoid gers a second valve that adds diluting gas (dilu-
valve
ent) from a separate cylinder. Air, trimix (helium,
nitrogen and oxygen) or heliox (helium and oxy-
gen) may be used as the diluent depending on the
planned depth and profile of the dive. The selec-
tion of the gas is determined largely by oxygen
toxicity and work of breathing issues. For the for-
mer, the diluent gas should not have a PO2 greater
Diluent Oxygen
than a predetermined set-point at depth (prefera-
bly a little lower so that an ‘oxygen spike’ does not
Figure 4.6 Electronic closed-circuit mixed gas
rebreather layout.
happen during descent when diluent is added to
the loop). To manage the latter, the diver should
Figure 4.6 shows the fundamental features of this calculate the density of the gas at the proposed
system. maximum depth, such that it does not exceed the
As with the closed-circuit oxygen unit, the manufacturer’s recommendation and maintains
diver inhales breathing gas from the counterlung the work of breathing within the specifications of
and exhales through the carbon dioxide absorber the unit.
back into the counterlung. As the diver consumes Manual controls and displays indicating the
oxygen, the PO2 in the counterlung falls, and this oxygen concentration are often fitted to allow the
fall is detected by oxygen sensors. At a certain diver to override the controls if the automatic
level, a valve injects more oxygen into the circuit. ­control fails. In many cases, divers also either raise
Both mechanically and electronically controlled the ‘set-point’ or flush the unit with oxygen during
units are commonly seen in recreational diving, the final decompression stop at 6 metres to shorten
and there has been much controversy as to which decompression time.
arrangement is safer. This system would appear to be the most effi-
Although all rebreather divers should know cient breathing system. It is more economical in
their PO2 at all times, the above argument hinges terms of gas usage than any other gear apart from
on the requirement for the diver in the manual sys- the oxygen-breathing apparatus. It enables a diver
tem to be forced to know his or her PO2 at all times to go deeper for longer and with fewer encum-
(although in most systems a basal flow of oxygen brances than other equipment.
is continually bled into the unit). However, the As an example of the efficiency of this type of
requirement to manage the PO2 in this system can equipment, it has been estimated that in a helium
create problems during times of high task loading. saturation dive program involving a prolonged
In contrast, there is less obvious compulsion for series of dives to 180 metres, the cost of helium
the diver using an electronic rebreather to know for a CCR apparatus was about 2.5 per cent of the
the PO2 at all times, and should the controlling cost of an SCR diving apparatus. These advantages
computer fail, the diver would be at risk, although must be balanced against the greater initial cost
the chances that the computer will fail in an elec- and complexity of the system. This complexity can
tronic rebreather are very low. The reality is that, lead to fatal malfunctions.
to date, neither system has been shown to offer a SCRs offer some of the saving in gas obtained in
survival advantage and all rebreather divers should the closed systems while avoiding the depth limita-
make a habit of knowing their PO2 at all times. tions of the oxygen sets and the greater complexity
Most modern mixed gas CCRs use a series of of the closed mixed gas sets. The basic system is
three redundant oxygen sensors (galvanic fuel cells) shown in Figure 4.7.
50 Diving equipment

a demand system when the diver is consuming

1 lpm of oxygen. This saving would increase if the
scuba diver was working harder and consuming
more air.
The high oxygen concentrations in both SCR
Constant
mass flow
and CCR systems mean that the diver may not
injector absorb as much nitrogen as he or she would if
Demand breathing air. This can give a decrease in the
valve decompression needed, but unless the PO2 in the
Nitrox
loop is actually measured, the diver must ‘guess-
timate’ the PO2 for decompression purposes. On
occasion, this has resulted in problems.
Military divers have traditionally been the main
users of SCR sets, although they have become
Figure 4.7 Semi-closed rebreathing system. increasingly popular in recreational diving. The
reduced gas flow with these sets means that they
SCRs typically use oxygen-enriched air (nitrox) can be designed to make little noise. If they are con-
as the breathing mix instead of oxygen. Two major structed from non-magnetic materials, they can be
types of SCR are in common use. The most com- used for dives near mines, although CCRs are now
mon is the constant mass flow (CMF) type, but the more often used for mine countermeasures.
keyed respiratory minute volume (RMV keyed)
type has some advocates, especially with US cave Problems with rebreathers
divers. Both CCR and SCR systems introduce a variety of
In a typical CMF SCR system, the gas flow and potential hazards (see Chapter 62):
composition are chosen for maximum efficiency Carbon dioxide accumulation can occur if
for the proposed dive. First, the composition of the the scrubber fails. This can occur if the scrub-
gas is chosen, with as high an oxygen concentra- ber material is used for too long, if the scrubber
tion as possible without creating an unacceptable is incorrectly attached or if the scrubber’s instan-
risk of oxygen toxicity at the planned maximum taneous capacity to remove carbon dioxide is
depth. This level may be changed depending on the exceeded because of a diver’s high demand, such
duration of exposure. The flow is then chosen so as with exertion.
that the diver will receive sufficient oxygen while Oxygen toxicity can occur if the diver exceeds
working on the surface. his or her depth limit, descends too quickly when
The oxygen concentration in the diver’s inspired diving at a particular PO2 (set-point) or uses a mix-
gas is determined by the flow into the system, the ture with too much oxygen in it. This can occur if
diver’s consumption and loss through the relief an excessively oxygen-rich mix was added to the
valve. It ranges from close to that in the supply diluent cylinder or if the solenoid or manual oxy-
­bottle when the diver is resting down to about gen injection valves jam open.
20 per cent when the diver is working at the maxi- Hypoxia may result if the gas flow decreases.
mum expected rate. This can be caused by omitting to turn on the gas
In the RMV keyed sets, a fixed volume of gas supply before descending, exhausting the oxygen
is dumped from the circuit with each breath, with supply, solenoid or electronics failure, and ascend-
‘new’ gas added via a demand valve. ing too rapidly to enable the solenoid to add suf-
As a safety precaution with an SCR, almost ficient oxygen to the loop. Hypoxia can also occur
invariably an excess of gas is added to the loop if the diver works harder than expected or if a mix
and is vented through the relief valve, thus mak- with too little oxygen is used.
ing these devices less efficient on gas than CCRs. A review of the 181 reported recreational CCR-
However, an SCR system with a flow of 12 lpm related deaths that occurred between 1998 and
gives an eightfold saving of gas compared with 2010 estimated that the fatality rate for CCR users
 Professional or technical diving equipment 51

was about 10 times that of recreational open-­circuit or a small submarine that keeps the diver in a
divers. The author also suggested that CCRs have a ­pressurized environment. At the end of the job,
25-fold increased risk of component failure com- possibly after several weeks, the pressure in the
pared with manifolded twin-cylinder open-­circuit DDC is lowered slowly to return the diver to atmo-
systems. It was suggested that this risk could be spheric pressure.
partly offset by carrying a redundant bail-out Transport vehicles can carry the divers at nor-
system. mal atmospheric pressure, at ambient pressure in
a dry environment or in a wet environment. These
Chambers, habitats and underwater include vehicles towed by a boat. A small motor
vehicles and propeller that pulls the diver along gives
increased speed with reduced effort. Some subma-
Divers may use several special types of vehicles rines have a lock system to allow divers to leave and
and living facilities. These include vehicles that enter underwater.
are hoisted and lowered to transport divers to One atmosphere diving equipment, such as
and from deep dive sites, propelled vehicles to the JIM suit, seals the diver in a pressure-resistant
increase the diver’s range and endurance (i.e. compartment. It has flexible arms with tools on the
diver propulsion vehicles [DPVs], often used by ‘hands’ for the diver to work underwater. The early
technical divers) and machines to carry underwa- types of suit had legs that gave the diver the ability
ter equipment. The accommodations to be consid- to walk on firm surfaces if there was little current.
ered include underwater houses and pressurized The diver had no control in mid-water and had to
houses at the surface. be lowered and hoisted from the surface. In other
Submersible decompression chambers (SDCs), designs, such as the Newtsuit and WASP system,
often called personnel transfer capsules, are used the diver controls a set of propellers that make him
to transport divers and any attendants from the or her a cross between a diver and a one-person
surface to the work site, and they may also be used submarine.
as a relay station and store for gas and equipment. Life support systems are required to provide
The most complex SDC may carry the diver at con- the occupants of all these vehicles, habitats and
stant pressure from a deck decompression cham- chambers with a respirable atmosphere. These
ber (DDC) to the work site and back. The simplest work on the same principles as a diver’s breath-
SDC consists of a bell chamber that is open at the ing apparatus, and in some vehicles the diver may
bottom and allows the diver to decompress in a dry even be wearing a breathing apparatus. The system
environment, exposed to the same pressure as the must be self-contained for transport vehicles, but
surrounding water. for habitats and SDCs the gas is generally supplied
Habitats are underwater houses that accom- from the surface.
modate divers in air- or gas-filled environments. Gas from the surface can be supplied in a free
They are used by divers to rest between excursions. flow and escape out the bottom or be recirculated
Divers have lived in some of these habitats for through a purifying system. Simple gas purify-
weeks at a time. ing systems can involve a hand-powered pump
Deck decompression chambers (DDCs) can to force gas through a carbon dioxide absorption
be small and used for surface decompression, a canister with a manually operated system for add-
procedure that allows a diver to be decompressed ing oxygen. The most complex systems are those
in a dry chamber instead of in the water. Larger found on large submersibles, nuclear submarines
chambers can be used to treat divers with decom- and chambers used for deep saturation dives.
pression illness and other diseases that respond to These have automatic closed systems with provi-
compression, in which case the chamber may be sion for removing trace contaminants and odours,
called a recompression chamber. and they also regulate temperature, pressure and
DDCs are also used to house divers for pro- humidity.
longed periods under elevated pressure. In this Gas reclaimers are mainly used to recover
case, divers are carried to their work by an SDC helium to be used again. They help to lower costs
52 Diving equipment

by reducing the amount of gas used. One type Mitchell SJ, Cronjé FJ, Meintjes J, Britz HC.
cools the gas until the other gases are liquefied, Fatal respiratory failure during a ­technical
leaving pure helium to be stored and used again. rebreather dive at extreme pressure.
Other types use a chromatographic technique to Aviation, Space and Environmental Medicine
separate the gases. 2007;78(2):81–86.
Rebreather Forum 3. http://www.rf30.org/
presentation/
FURTHER READING US Navy Diving Manual Revision 6 SS521-AG-
PRO-010 (2008). Washington, DC: Naval Sea
Bozanic JE. Mastering Rebreathers. Flagstaff,
Systems Command; 2008.
Arizona: Best Publishing Company; 2002.
Fock A. Analysis of recreational closed-circuit
This chapter was reviewed for this fifth edition by
rebreather deaths 1998–2010. Diving and
John Lippmann.
Hyperbaric Medicine 2010;43(2):78–85.
 5
Undersea environments

Introduction 53 Night diving 59

Altitude diving 53 Water movements 59
Cave and wreck diving 55 White water 59
Cave diving 55 Surge 59
Wreck diving 56 Inlets and outlets 59
Cold/ice diving 56 Tidal currents 59
Deep diving 57 Surf 61
Fresh water diving 58 Further reading 62
Kelp diving 58

INTRODUCTION the effects of cold (see Chapters 27 and 28), ­a ltitude

and fresh water diving (see Chapter 2), explo-
For the diver who is adequately trained and physi- sives (see Chapter 34), depth (see Chapters 2, 15,
cally fit, who is aware of the limitations of the 20, 46 and 68) and marine animal injuries (see
­equipment and who appreciates the specific require- Chapters 31 and 32). Other environmental topics
ments of different environmental diving conditions, that are covered more comprehensively in diving
the sea is rarely dangerous. Nevertheless, it can be texts are summarized in this chapter.
hazardous and unforgiving if attention is not paid Being kept underwater and exceeding the lim-
to all these factors. ited air supply will result in drowning. This is a
Diver training is specific to the environment in situation common to many of the hazardous envi-
which the diver is trained. Specialized techniques ronments, including caves and wrecks and under
are recommended to cope with different environ- ice, overhangs, water flows and so forth. A variety
ments. They cannot be automatically extrapolated of materials can trap the diver, including kelp, lines
to other diving environments. The induction of fear (even ‘safety’ lines), fishing nets and fishing lines.
in the inexperienced diver and of physical stress in If the diver does not have a compromised air sup-
the more skilled diver is appreciated only when one ply, then knowledge of the environment, a buddy,
examines each specific environmental threat. These a communication facility, a calm state of mind and
environmental stresses are mentioned in this and a diving knife or scissors will cope with most of
other chapters. The reason for including them in a these circumstances.
medical text is that unless the physician compre-
hends the problems and dangers, the medical exami- ALTITUDE DIVING
nations for diving fitness and the assessments of
diving accidents will be less than adequate. The term altitude diving refers to diving at an alti-
Some aspects of the environments have physi- tude of 300 metres or more above sea level. Non-
ological and pathological sequelae and therefore diving disorders should be considered, such as the
have specific chapters devoted to them. They include dyspnoea and hypoxia induced by high altitude
53
54 Undersea environments

and the altitude sickness that frequently develops decompression stops, the nitrogen load in tissues
above 3000 metres. Diving at altitudes higher than afterward, the safe durations before flying or repet-
this is strongly discouraged. itive diving, the ascent rates recommended during
The following numerical examples do not rep- diving and so forth. Formulae are available to con-
resent actual diving conditions and are used to vert the equivalent altitude decompressions to sea
explain the problems as simply as possible, thus level decompressions.
avoiding complicated mathematics. The conven- Another problem of diving in a high-altitude
tional idea of diving is that a diver descends with lake is the rate at which a diver may have to exhale
the sea surface (1 ATA) as the reference point and during ascent. A diver who ascends from 10 metres
returns there when he or she has finished the dive. (2 ATA) to the ocean surface (1 ATA) would find that
A diver may have to dive at altitude, in a mountain the volume of gas in the lungs has doubled. Most
lake or dam, where the pressure on the surface is divers realize this and exhale at a controlled rate
less than 1 ATA. Problems stem from the physics during ascent. They may not realize that an equiva-
at this altitude. lent doubling in gas volume occurs in only 5 metres
For simplicity’s sake, the following descrip- of ascent to the surface, if the dive was carried out at
tion is based on the useful, but not strictly cor- an altitude (pressure) of 0.5 ATA. Equivalent effects
rect, traditional theory that the ratio between the are encountered with buoyancy, which can more
pressure reached during the dive and the final rapidly get out of control at altitude.
pressure determines the decompression required. The diver’s equipment can also be affected or
If this ratio is less than 2:1, then a diver can ascend damaged by high-altitude exposure. Some pres-
safely without pausing during ascent. This means sure gauges start to register only when the pressure
that a diver from the sea surface (1 ATA) can dive is greater than 1 ATA. These gauges (oil-filled, ana-
to 10 metres (2 ATA) and ascend safely, as regards logue and mechanical types) may try to indicate a
decompression requirements. A diver operating negative depth, perhaps bending the needle, until
in a high mountain lake, with a surface pressure the diver reaches 1 ATA pressure. Thus, the dive
of 0.5 ATA, could dive only to 5 metres (1 ATA) depth would have to reach more than 5 metres
before he or she had to worry about decompres- before it even started measuring, if the dive had
sion. This statement ignores the minor correction commenced at an altitude of 0.5 ATA.
required with fresh water. Fresh water is less dense The other common depth gauge, a capillary
than salt water. tube, indicates the depth by an air-water boundary.
Another pressure problem occurs when a diver, It automatically adjusts to the extent that it always
who dives at sea level, then flies or ascends into the reads zero depth on the surface. The volume of
mountains after the dive. For example, a 5-metre gas trapped in the capillary decreases with depth
dive (1.5 ATA) from sea level could be followed (Boyle’s Law). For a diver starting from 0.5 ATA
by an immediate ascent to a pressure (altitude) of altitude, this gauge would read zero, but it would
0.75 ATA, with little theoretical risk. Deeper dives show that the diver had reached 10 metres when
or greater ascents may require the diver to pause at he or she was only at 5 metres depth. Theoretically,
sea level if the diver is to avoid decompression sick- the diver could plan the dive and decompression
ness. If the diver ascends, in a motor vehicle or an according to this ‘gauge’ depth, but only if he or she
airplane, the reduced pressure will expand ‘silent’ was very courageous.
bubbles or increase the gas gradient to produce Many electronic dive computers do permit cor-
larger bubbles, thereby aggravating the diseases rection for altitude, and some need to be ‘re-zoned’
of pulmonary barotrauma and decompression at the dive site. Other decompression meters are
sickness. damaged by exposure to altitude (e.g. as in aircraft
Thus, exposure to altitude after diving, or div- travel), and the applicability of other dive comput-
ing at altitude, increases the danger of decompres- ers to altitude diving or saturation excursions is
sion sickness, compared with identical dives and questionable.
exposures at sea level. It influences the decom- Divers who fly from sea level to dive at altitude,
pression obligations, the depths and durations of as in high mountain lakes, may commence the dive
 Cave and wreck diving 55

with an already existing nitrogen load in excess of The diver descends, often through a small
that of the local divers, who have equilibrated at access, passes down a shaft, goes around a few
the lower pressures. Thus, the ‘sea level’ divers are bends and is faced with multiple passages, in total
in effect doing a repetitive dive, and ‘residual nitro- darkness. Under these conditions, and to make
gen’ tables must be employed. this particular type of diving safe, it is necessary
Decompression tables that supply accept- to be accompanied by a diver who has consider-
able modifications for altitude exposure include able cave experience – in that cave – and whose
the Buhlmann and Canadian Defence and Civil judgement is trustworthy. It is equally important
Institute of Environmental Medicine (DCIEM) that the equipment is both suited to cave diving
tables (see Appendix A). and totally replaceable with spares during the
Altitude exposure and altitude diving are more dive. Apart from the obvious environmental dif-
hazardous extensions of conventional diving. ficulties inherent in diving through a labyrinth of
They are not as well researched, and the greater passageways, there are added specific problems.
the altitude, the more applicable is this statement. Safety in cave diving is not usually achievable
It includes not only the problems already men- by immediate surfacing. Thus, all necessary equip-
tioned, but also the complication of diving in fresh, ment must be duplicated for a long return swim,
often very cold, water. This water may contain at depth, and possibly while rescuing a disabled
debris that has not decomposed as it would in the companion.
ocean and may therefore threaten entrapment. The Air pockets found in the top of caves are
sites are often distant from diving medical facili- sometimes non-respirable because of low oxy-
ties. Undertaking a specialized course in altitude gen and high carbon dioxide levels (especially in
diving is a basic prerequisite. limestone caves), so when entering this pocket,
breathing should be continued from the scuba
CAVE AND WRECK DIVING equipment. Sometimes the roof of the cave is
supported by the water, and when this water is
These enclosed environments are hazardous to replaced by air from the diver’s tanks, the roof
open water divers. Cave diving and wreck diving are can collapse. The common claim that ‘the diver
more complex than they first appear. Completion of was so unlucky for the roof to collapse while
the open water scuba training course is inadequate he was there’ is incorrect. It collapsed because he
preparation for cave and wreck diving. Planning was there.
involves not only the setting of goal-oriented The minimum extra safety equipment includes
objectives, but the delineation of maximum lim- a compass, powerful lights and a safety reel and
its (depths, distances). The main problems are as line. It is a diving axiom that entry into a cave is
follows: based on the presumption that the return will have
to be carried out in zero visibility.
●● No direct ascent to the surface (i.e. safety). For visibility, each diver takes at least two
●● Disorientation and entrapment. lights; however, other factors can interfere with
●● Loss of visibility. the function of these lights. A great danger is
●● Enclosed spaces and panic. the silt that can be stirred up if the diver swims
along the lower part of the cave or in a head-up
Cave diving position (as when negatively buoyant). If there is
little natural water movement, clay silts can be
The techniques of cave diving are very rigidly delin- very fine and easily stirred up. It is for this reason
eated. Specialized training includes dive planning, that fins should be small, and the diver should be
the use of reels and lines and the lost diver proto- neutrally buoyant and should swim more than a
cols. Most people who have difficulties with cave metre above the bottom of the cave. Visibility can
diving have not followed the recommended rules, be totally lost in a few seconds as the silt curtain
and unfortunately cave diving problems tend to ascends, and it may remain that way for weeks.
cause multiple fatalities. Sometimes it is inevitable, as exhaled bubbles
56 Undersea environments

dislodge silt from the ceiling. Layering of salt penetrations, not vertical. Otherwise, entangle-
and fresh waters also causes visual distortion and ment is likely with rapid ascents, especially if
blurring. divers precede the lead diver. Thin, non-floating
The usual equipment includes double tanks man- lines especially cause entanglement if they are
ifolded together, making a common air supply, but allowed to slacken.
offering two regulator outlets. With the failure of Specialized cave diving training is a ­prerequisite
one regulator, the second one may be used for the air for this diving environment.
supply – or as an octopus rig. The second regulator
must have a long hose, given that often divers cannot Wreck diving
swim alongside each other. Because of space limita-
tions, buddy breathing is often impractical under Wreck diving has potentially similar problems
cave conditions. An extra air supply (‘pony’ bottle) to some cave and ice diving. In addition, it has
is advisable. the hazards of instability of the structure and the
For recreational divers to explore caves, the dangers of unexploded ordnance, sharp objects,
ideal equipment is a reliable compressed air sur- toxic cargo and fuel. Exhausted gas from scuba
face supply, with a complete scuba back-up rig. may cause air pockets and disrupt the wreck’s
All the instruments should be standardized; e.g. stability.
the watch goes on the left wrist, the depth gauge Silt in wrecks is usually heavier than that in still
above it, the compass on the right wrist and the water caves. Thus, the sudden loss of visibility that
dive computer (this can include a contents gauge, can occur when silt is stirred up may be less persis-
decompression meter, dive profile display, com- tent. The diver should ascend as far as is safe and
pass) attached to the harness under the left arm. wait until the silt cloud settles down.
The gauges and decompression must be modified
for fresh water and altitude, if these are applicable. COLD/ICE DIVING
The knife is strapped to the inside of the left leg, to
prevent entanglement on any safety lines. The obvious problems are those of cold and hypo-
The buoyancy compensator is often bound thermia. They are so obvious that most people will
down at the top, to move the buoyancy centre more avoid them by the use of heating systems, drysuits
toward the centre of gravity (cave divers do not need or efficient wetsuits. See Chapters 27 and 28 for
to be vertical with the head out of water). There is the effects of a cold environment on physiological
no requirement for excess buoyancy because safety performance.
in cave diving is not usually equated with a direct A major difficulty with cold and ice diving is the
ascent; thus, any carbon dioxide cylinders should tendency of many single hose regulators to freeze,
be removed and replaced with exhausted ones to usually in the free-flow position, after about 20 to
prevent accidental inflation of vests. A principle of 30 minutes of exposure to very cold water (less
cave diving is that safety lies in retracing the entry than 5°C). This situation is aggravated if there is
path by the use of lines and not by ascent, as in the water vapour (potential ice crystals) in the com-
normal open ocean diving. pressed air and if there is a rapid expansion of air,
Preferably no more than three divers should which produces further cooling in both first and
undertake a single dive, and on completion of the second stages. The first stage or the second stage
dive each should have a minimum of one third of may then freeze internally.
the initial air supply. If there is water flow within Expansion of air as it passes from the high tank
the cave, and the penetration is with the flow, this pressure to the lower pressure demand valve and
reserve air supply may not be adequate because the then to environmental pressures (adiabatic expan-
air consumption is greater when returning against sion) results in a drop in temperature. It is therefore
the current. not advisable to purge regulators if exposed to very
Vertical penetrations need a heavy shot line cold temperatures. The freezing from increased air
moored or buoyed at the surface and weighted or flow follows exertion, hyperventilation or panic.
fixed at the bottom. The reel is used for horizontal Octopus rigs become more problematic to use
 Deep diving 57

under these conditions, or at great depth, because insulating ability. In that case, non-­ compressible
of this increased air flow. An emergency air source wetsuits, inflatable drysuits or heated suits are
(pony bottle) has replaced buddy breathing and required. In Antarctic diving, to gain greater dura-
octopus rigs. tion, we had to employ a wetsuit or other thick cloth-
‘External’ ice is formed in and around the ing under a drysuit.
first (depth compensated) stage of the regulator, Ice diving is in many ways similar to cave div-
thus blocking the orifice and interfering with the ing. It is essential that direct contact must always
spring. Moisture from the diver’s breath or water be maintained with the entry-exit area. This should
in the exhalation chamber of the second stage may be by a heavy-duty line attached to the diver via a
also freeze the demand mechanism, causing free bowline knot. The line must also be securely fas-
flow of gas or ‘internal’ freezing with no flow. tened at the surface, as well as on the diver. The
Modifications designed to reduce freezing of dive should be terminated as soon as there is a
the water in the first stage include the use of very reduced gas supply or any suggestion of cold expo-
dry air and the replacement of first-stage water-­ sure with shivering, diminished manual dexterity
containing areas with silicone, oils or alcohols and so forth.
(which require lower temperatures to freeze) or The entry hole through the ice should be at least
with an air flow from the regulator. The newer, two divers wide. Allowing room for only one diver
non-metallic second stages are less susceptible to enter ignores two facts. First, the hole tends to
to freezing. Despite all this, regulator freezing is close over by freezing. Second, in an emergency
common in polar and ice diving. Surface supply two divers may need to exit simultaneously. There
with an emergency scuba, or twin tank–twin regu- should be a surface tender with at least one standby
lator diving, as with cave diving, is probably safer. diver. A bright light, hanging below the surface at
It must be presumed in under-ice diving that the the entry-exit hole, is also of value in identifying the
regulator will freeze and induce an out-of-air situ- opening. If large diving mammals contest the open-
ation, and this must be planned for. ing in the ice, they should be given right of way.
Under ice there is little use for snorkels, and If the penetration under the ice is in excess of
so these should be removed to reduce the likeli- a distance equated with a breath-hold swim, then
hood of snagging. Rubber suits can become sharp a back-up scuba system is a requirement, as with
and brittle. Zippers are best avoided because they cave diving.
freeze and may also allow water and heat exchange.
Buoyancy compensators should be small and with DEEP DIVING
an independent air supply.
As a general rule, and if well-fitting drysuits ‘Divers do it deeper’ represents a problem with
are unavailable, the minimum thickness of the ego trippers and a challenge to adventure seekers.
Neoprene should increase with decreased water Unfortunately, the competitive element sometimes
temperatures, as in the following examples: overrides logic, and divers become enraptured,
literally, with the desire to dive deeper. They then
<5°C – 9-mm-thick wetsuit move into a dark, eerie world where colours do not
<10°C – 7-mm-thick wetsuit penetrate, where small difficulties expand, where
<20°C – 5-mm-thick wetsuit safety is farther away and where the leisure of rec-
<30°C – 3-mm-thick wetsuit reational diving is replaced with an intense time
urgency.
Hood, gloves and booties should be of a con- Beyond the 30-metre limit the effect of narco-
siderable thickness, or heat pads can be used. Heat sis becomes obvious, at least to observers. The gas
pads must not be in contact with high-oxygen supply is more rapidly exhausted and the regulator
gases because overheating can result. is less efficient. Buoyancy, resulting from wetsuit
Unheated wetsuits do not give sufficient insula- compression, has become negative, with an inevi-
tion at depth (beyond 18 metres) when the Neoprene table reliance on problematic equipment, such as
becomes too compressed and loses much of its the buoyancy compensator. The reserve air ­supply
58 Undersea environments

does not last as long, and the buoyancy compen- as an anchor chain for people to use when they
sator inflation takes longer and uses more air. are equalizing their ears, as well as to attach other
Emergency procedures, especially free and ­buoyant objects such as floats, diver’s flags, surf mats, speci-
ascents, are more difficult. The decompression men bags and so forth.
tables are less reliable, and ascent rates become Giant members of this large brown algae or
more critical. seaweed may grow in clear water to depths of
Overcoming some problems leads to unintended 30 metres. The growth is less in turbid or unclear
consequences. Heliox (helium-oxygen mixtures) water. Kelp usually grows on hard surfaces, e.g. a
reduces the narcosis of nitrogen, but at the expense rocky bottom, a reef or, for more romantic divers,
of thermal stress, communication and altered a Spanish galleon. It is of interest commercially
decompression obligations. Inadequate gas supplies because it is harvested to produce alginates, which
can be compensated by larger and heavier cylinders, are useful as thickening, suspending and emulsify-
or even by rebreathing equipment, but with many ing agents, as well as in stabilizing the froth on the
adverse sequelae (see Chapter 62). diver’s glass of beer (après dive, of course).
Many of the older, independent instructors Kelp has caused many diving accidents, often
would qualify recreational divers only to 30 metres. with the diver totally bound up into a ‘kelp ball’
Now, with instructor organizations seeking other that becomes a coffin. The danger of entanglement
ways of separating divers from their dollars, spe- is related to panic actions and/or increased speed
cialty courses may be devised to entice divers to and activity of the diver while in the kelp bed.
‘go deep’ before they have adequately mastered the Twisting and turning produce entanglement.
shallows. Divers who are accustomed to kelp diving
usually take precautions to ensure that there is
FRESH WATER DIVING no equipment that can snag the strands of kelp;
i.e. they tend to wear knives on the inside of the
The main problem with fresh water is that it is not the leg, tape the buckles on the fin straps, have snug
medium in which most divers were trained. Thus, quick-release buckles and not use lines. Divers
their buoyancy appreciation is distorted. Acceptable descend vertically feet first to where the stems are
weights in sea water may be excessive in fresh water. thicker and there is less foliage to cause entangle-
Depth gauges are calibrated for sea water, and so ment. The epitome of bad practice in kelp diving
they need to be corrected for diving in dams, lakes, is to perform a head first roll or back roll because
quarries and so forth. Because these waters are often it tends to result in a ‘kelp sandwich with a diver
stationary, there may be dramatic thermoclines, filling’.
requiring adjustments for thermal protection and The kelp is pushed away by divers as they slowly
buoyancy, as one descends. descend and ascend; i.e. they produce a clear area
There are also many organisms that are destroyed within the kelp, into which they then move. They
by sea water but that thrive in warm fresh water. ensure that they do not run out of air because this
Some of these, such as Naegleria, are fatal. situation will produce more rapid activity. If they
do become snagged, divers should avoid unneces-
KELP DIVING sary hand and fin movements. Kelp can be sepa-
rated either by the use of a knife or by bending
Kelp beds are the equivalent of underwater for- it to 180 degrees, when it will often snap (this is
ests. Kelp can be useful in many ways to the diver. more difficult to achieve while wearing gloves). It is
It allows a good estimate of clarity of the water by unwise to cut kelp from the regulator with a knife
assessing the length of plant seen from the surface. without first clearly differentiating it from the reg-
The kelp blades indicate the direction of the pre- ulator hose. Some divers have suggested biting the
vailing current. In kelp beds there is usually an strands with one’s teeth. This may be excellent as
abundance of marine life, and the kelp offers other regards dietary supplementation, kelp being high
benefits such as dampening wave action both in in both B vitamins and iodine, but it does seem
the area and the adjacent beach. Kelp can be used overly dramatic.
 Water movements 59

Kelp does float, and it can often be traversed on WATER MOVEMENTS

the surface by a very slow form of dog paddling
or ‘kelp crawl’, in which one actually crawls along Because of the force of water movement, a diver
the surface of the water, over the kelp. This can be can become a hostage to the sea.
done only if the body and legs are kept flat on the
surface, thus using the buoyancy of both the body White water
and the kelp, and by using the palms of the hands
to push the kelp below and behind as one proceeds This water is white because of the foaming effect of
forward. Any kicking that is performed must be air bubbles. This dramatically interferes with both
very shallow and slow. visibility and buoyancy, as well as implying strong
currents or turbulent surface conditions. A diver in
NIGHT DIVING white water is a diver in trouble. Under these condi-
tions, the recommendation is usually to dive deeper.
Because of the impaired visibility, extra care is
needed for night diving. Emergency procedures Surge
are not as easy to perform without vision. There is
a greater fear at night. For inexperienced divers it The to-and-fro movement of water produces dis-
is advisable to remain close to the surface, the bot- orientation and panic in inexperienced divers, who
tom or some object (e.g. anchor, lines). Free swim- often try to swim against it. Other divers use the
ming mid-water and without objects to focus on surge by swimming with it, then hold onto rocks
causes apprehension to many divers. or corals when the surge moves in the opposite
Preferably the site should be familiar, at least direction. This approach may be detrimental to the
in daylight, without excessive currents or water ­ecology, but good for survival.
movements and with easy beach access – diving
between the boat and the shore. On entry the diver Inlets and outlets
sometimes encounters surface debris that was not
obvious from the surface. Occasionally, there is a continuous water flow,
Any navigational aid needs to be independently because of a pressure gradient through a restricted
lighted. This includes the boat, the exit, buoys, opening, which can siphon and hold (or even
buddies and so forth. A chemoluminescent glow extrude) the diver. It is encountered in some caves,
stick (Cyalume light) should be attached firmly blue holes or rock areas near surf (an underwater
to the tank valve, and at least two reliable torches ‘blow hole’), in human-made structures such as the
should be carried. The snorkel should have a fluo- water inlets in ships’ hulls and in outlets in dams
rescent tip. A compass is usually required. A whis- and water cocks (taps). The pressure gradient may
tle and a day-night distress flare are sometimes of slowly draw the diver into its source and then seal
great value in summoning the boat operator, who him or her in, like a bath plug. Protection is by not
has not the same capabilities of detecting divers at occluding these inlets and by avoiding the area or
night. covering it with a large grating.
Marine creatures are sometimes more difficult
to see. Accidents involving submerged stingrays Tidal currents
and needle spine sea urchins are more likely.
Signals include a circular torch motion (‘I am These currents are very important to the diver. If
OK, how about you?’) or rapid up and down move- used correctly, they take the diver where he or she
ments (‘something is wrong’). The light should wants to go. Otherwise, they are likely to take the
never be shone at a diver’s face because it blinds diver where he or she does not want to go. The lat-
him or her momentarily. Traditional signals can be ter event can be both embarrassing and terrifying,
given by shining the light onto the signaling hand. and it can also be very physically demanding.
Waving a light in an arc, on the surface, is a sign Frequently, divers are lost at sea because of cur-
requesting pickup. rents. Sometimes these currents can be vertical and
60 Undersea environments

cannot be combated by swimming or buoyancy. underwater and return with ease if desired or to
Certain popular diving areas, such as at Palau (espe- rescue a companion.
cially Pelalu), Ras Muhammad, the Great Barrier The lines attached to the boat are of extreme
Reef and Cozumel, are famous for their currents, importance when there are currents. First, there is
and multiple fatalities are not uncommon. the anchor line, and this is the recommended way
Divers sometimes relate their successful swims to reach the sea bed upstream from the boat. The
against 4- to 5-knot currents. In fact, the aver- anchor chain should not be followed right down
age fast swim approximates 1.2 knots. For brief to the anchor because this may occasionally move
periods, it may be possible to reach up to 1.5 if the boat moves, and it can cause damage to the
knots. The average swimmer can make very slow adjacent divers. More than one diver has lost an
progress or none at all against a 1-knot current. eye from this ‘freak accident’. How may the diver
A half-knot current is tolerable, but most div- reach the anchor line? A line may be attached to
ers experience this as a significant problem, and the top of the anchor line, with the other end to the
so it is. They tend to exaggerate the speed of the stern of the boat. It should have enough play in it
current as the hours go by, and especially during to allow divers to sit on the side of the boat and to
the après-dive euphoria (1 knot = approximately hold it with one hand – the hand nearest the bow
2 km/hour). of the boat – while using the other hand to keep the
Tidal currents are usually much faster on the face mask and demand valve in place. On entry, the
surface than they are on the sea bed because of diver ensures that he or she does not let go the line.
friction effects. A helpful observation is that the The diver then pulls himself or herself forward to
boat will usually face the current with its anchor the anchor line and descends.
upstream and the stern of the boat downstream. Perhaps the most important line, if there is a
Any diver worth his or her salt knows that it is current, is a float line or ‘Jesus’ line. This line drags
safer to swim against the current for the first half 100 metres or more behind the boat, in the direc-
of the usable air and allow the current to bring the tion of the current, and it has some floats to ensure
diver back to the boat for the second half of the that it is always visible to divers on the surface. It is
dive. The ‘half-tank rule’ is worked out by tak- often of value to have one diver on this line while
ing the initial pressure, say 200 ATA, subtract the the others are entering the water. The diver on the
‘reserve’ pressure (the pressure needed to charge line virtually acts as a backstop to catch the odd
the regulator), say 40 ATA, i.e. 160 ATA, and divide stray diver who has not followed instructions and
this by 2, i.e. 80 ATA. Thus, for this example, 80 is now floating away with the current. The Jesus
ATA is used on the outward trip, and then the line is also of immense value at the end of the dive
return is made with ample air to allow for misad- when divers have, incorrectly, exhausted their air
venture (e.g. navigational error). supply or when they come to the surface for some
Untrained divers tend to make unplanned other reason and find themselves behind the boat.
dives. They submerge and ‘just have a look around’. This would not have happened had a dive plan been
While they are having their look around they are constructed and followed correctly. Occasionally,
being transported by the current, away from the however, it does happen to the best divers, and it is
boat, at a rate of 30 metres every minute in a 1-knot of great solace to realize that the Jesus line is there
current. When they consider terminating the dive, and ready to save the sinner – irrespective of reli-
after they have used most of their air, they have a gious persuasion.
very hard return swim against the current. They Even divers who surface only a short way behind
surface, because of their diminished air supply, the boat in a strong surface current may find that
well downstream from the boat and have to cope it is impossible to make headway without a Jesus
with a faster, surface current. This is a very diffi- line. If this is not available, they can descend and
cult situation and far more hazardous, than that of use their compass to navigate back to the anchor
the experienced diver who used the half-tank rule, line or inflate the buoyancy compensator, attract
who surfaced upstream from the boat and floated the attention of the boat lookout and hope to be
back to it, but who also had enough air to descend rescued.
 Water movements 61

Buddy breathing while swimming against a off Florida and the Torres Strait, but tidal currents
strong current is often impossible. Even the octo- are likely to give an hour or more of slack water
pus (spare) regulator is problematic at depth or with the change of tide. At these times diving is
when two people are simultaneously demand- usually safer and more pleasant because the sedi-
ing large volumes of air, typical of divers swim- ment settles and enhances visibility. To ascertain
ming against a current. An alternative air supply the correct time for slack water, reference has to be
(a reserve or pony bottle) is of value, if it has an made to the tidal charts for that area. The speed
adequate capacity. of the current can be predicted by the tidal height.
In dive planning, there should be at least one
accessible fixed diving exit, easily identifiable, that Surf
serves as a safe haven. This may be an anchored
boat, in areas with tidal currents. The safety boat Entry of a diver through the surf is loads of fun
is a second craft – not anchored – and this, like any to an experienced surf diver. Otherwise, it can be
boat that is driven among divers, needs a guard on a tumultuous moving experience and is a salutary
its propeller. To attract the safety boat, various res- reminder of the adage ‘he who hesitates is lost’. The
cue options include the following: major problem is that people tend to delay their
entry at about the line of the breaking surf. The
●● A towed buoy. diver, with all his or her equipment, is a far more
●● An inflatable 2-metre-long bag, called the vulnerable target for the wave’s momentum than is
‘safety sausage’, to attract attention. any swimmer.
●● Pressure tested distress flare (smoke/light). The warning given to surfers, referring to water
●● Personal floatation devices. colour, is that ‘White is right but green is mean and
●● Personal electronic, sonic or luminous location blue is too’. This ensures that the surfer enters the
devices. surf and avoids rips. For the diver, it is the oppo-
site. The diver may use the apparently calmer water
Divers can now carry a personal location bea- to ride the rip into the ocean.
con or emergency position-indicating radio bea- When the surf is unavoidable, the recommen-
con (EPIRB), especially of value if diving in fast dation is that the diver should be fully equipped
currents. These devices need to be pressure pro- before entry and not re-adjust face masks and fins
tected and are of value only once on the surface. until he or she is well through the surf line. The fins
There are other problems with currents, and and face mask must be firmly attached beforehand
these are especially related to general boat safety because it is very easy to lose equipment in the surf.
and ensuring that there is a stable anchorage. The diver walks backward into the surf while look-
When the current is too strong or the depth or ing over his or her shoulder at the breakers and
sea bed is not suited to an anchored boat, a float or also toward a buddy. The face mask and snorkel
drift dive may be planned. This requires extreme have to be held on during the exposure to breaking
care in boat handling. Divers remain together and waves. The regulator must be attached firmly to the
carry a float to inform the safety boat of their posi- jacket, with a clip, so that it is easily recoverable at
tion. It allows the surface craft to maintain its posi- all times.
tion behind the divers as they drift. When a wave does break, the standing diver
The concept of ‘hanging’ an anchor, with divers presents the smallest possible surface area to it;
drifting in the water near it and the boat being at i.e. he or she braces against the wave, sideways,
the mercy of the elements, has little to commend it. with feet well separated, and he or she crouches
The raising of the diver’s flag under such ­conditions, and leans, shoulder forward, into the wave. As
although it may appease some local authorities, is soon as possible, the diver submerges and swims
often not recognized by the elements, reefs or other (in preference to walking) through the wave area.
navigational hazards, including moored boats. If the diver has a float, then this is towed behind.
Some currents are continuous, e.g. the standing It should never be placed between the diver and
currents of the Gulf of Mexico, the Gulf Stream the wave.
62 Undersea environments

Exit should be based on the same principle as Exley S. Basic Cave Diving. Jacksonville, Florida:
entry, except then the surf is of value. The wave may National Speleological Society; 1981.
be used to speed the exit by swimming immediately National Oceanographic and Atmospheric
behind it or after it has broken. The float then goes Administration. NOAA Diving Manual. 5th ed.
in front of the diver and is carried by the wave. Washington, DC: US Government Printing
Office; 2013.
FURTHER READING Royal Australian Navy Diving Manual, ABR 155.
Dept of Defence, Royal Australian Navy,
Australian Antarctic (ANARE) Diving Manual, Canberra, ACT, Australia Current edition.
Australian Antarctic Division, Kingston, US Navy Diving Manual Revision 6 SS521-AG-
Tasmania, Current edition. PRO-010 (2008). Washington, DC: Naval Sea
British Sub-Aqua Club Diving Manual. Systems Command; 2008.
ISBN: 9781905492220. Hutchinson, U.K.
Current edition. This chapter was reviewed for this fifth edition by
Lippmann J, Mitchell S. Deeper Into Diving. Carl Edmonds.
2nd ed. Melbourne: Submariner Publications;
2005.
 2
Part    

Dysbaric Diseases: Barotraumas

6 Pulmonary barotrauma 65
7 Ear barotrauma 81
8 Sinus barotrauma 103
9 Other barotraumas 115