Join Richard Cullen from Deptherapy as we publish part 3 in his Blog about the charity’s recent expedition to Roots Red Sea, El Quseir, Egypt.

Today was planned to be our first day of open water diving in the Red Sea on the Roots’ House Reef. The Dive Centre and the House Reef are literally a 5-minute walk from the camp.  If some beneficiaries are unable to make the walk then transport is provided.

All your kit, weights, cylinders etc are laid out ready for you to assemble your kit.

For those who use wheelchairs there is a paving stone pathway from the dive centre to the entry point for the reef. This, as with the provision of four fully accessible rooms in the resort, was built by Steve Rattle and his team to meet Deptherapy’s needs and to make the resort and reef accessible to all divers with disabilities.

A point here: in many Adaptive Teaching/Disabled Diving Manuals it is suggested that dive centres might wish to purchase a beach wheelchair.  To justify the cost, you would need a considerable number of disabled clients who were unable to walk to the ocean entry point as they cost circa £3000.  Using an individual’s wheelchair across sandy beaches is difficult and not a good idea. Many wheelchairs, such as Corey’s, cost thousands of pounds and getting sand/grit in the bearings can result in costly repairs.  So, at Roots the staff have adapted and overcome the challenge, with the beach wheelbarrow.  A foam pad is placed in the bottom and a towel draped over it.  It is effective and allows divers like Corey to be taken to the beach, the wheelbarrow is pushed into shallow water and the diver either gets out of the transport himself or is lifted out by the Roots team.  Everyone finds it a lot of fun!

Your transport awaits!

Working with those with life-changing mental and/or physical challenges does require careful risk management, not just in the general risk models for groups of divers but individual risk assessments.

On the Deptherapy Education Professionals’ Course and adopted in all our programmes is the ‘Three Tick Model’. Before taking an individual diving, each of the following must be ticked off:

• Doctor certifies student fit to dive
• Student signs assumption of Liability and Risks
• Instructor is happy given the medical information to instruct the student.

As an Instructor, or as a dive centre owner you may wish to check that your insurance covers you for working with those with severe disabilities.

The instructor will meet with the student and complete a personalised risk assessment and will review whether there have been any changes in the student’s physical or mental health since their consultation with their doctor (in our case an AMED or Dive Referee).  They will also check that the medication or its daily dosage has not changed.

In terms of those with severe challenges, an AMED or a Dive Referee may require full disclosure of medical records before making a decision.  For Deptherapy we also reserve the right to refer a final decision to our two medical advisors, Dr Mark Downs or Dr Oli Firth, both of whom have considerable experience in dive medicine.

At the end of Day 1 the team were happy for Keiron to move forward; he is a strong, fit man and a capable diver who gives 100%.  Corey is an amazing guy and was very quickly embraced as a member of the Deptherapy ‘family’. But sometimes there has to be tough love and in Deptherapy we are always very open with our beneficiaries.  Some reach a level of certification beyond which they cannot progress.  For Corey there was a serious discussion with the teaching team. He had completed his skills in the pool and met the standard required BUT none of us, especially me, had any confidence that he was the standard to be an Open Water Diver.  A hard message to give to a young man who already had a certification card that said he was an Open Water Diver.  He had either not been taught properly and certified without having met the required standards or he had forgotten all he had learned.  My view is he is a bright young man and that the former reason must be correct.

Corey, Keiron and Swars between confined dives by the Roots pool

The RAID definition of mastery:

‘When a student/learner can comfortably demonstrate proficiency and competence, when completing an entire motor skill including all the components of the skill in a manner that demonstrates minimal stress or hesitation.’

Each mainstream diving training agency defines mastery in similar terms. It was not Corey’s ability to do the skills, it was his ability to ‘dive’ that concerned us.

If weather conditions are right, the Roots House Reef meets the requirements for a ‘confined environment’ and on Day 3 it did.

Entry to the reef is through a channel and it goes from extremely shallow to 3-5 metres.  There is a rope that allows a diver to control their descent and for use at the end of a dive if the current is running.

Most instructors will have seen nervous divers who say they have ear issues, not at a depth when there is any noticeable change in pressure, and those who continually fidget with their masks and other kit in an attempt to avoid descent. Corey displayed these traits.

We made the decision to move to the open water as it would give Corey more of an opportunity to get himself in a horizontal position rather than the upright position we saw in the pool.  We struggled to get him down the line and into the sea.  Eventually after much hard work we got there.  He maintained the upright position and was using tiny arm and hand movements to propel himself forward.  His buoyancy was poor.  We decided to end this session and return to the pool.

A note here on trim and posture in the water for both amputees and those with paraplegia.  When working with a leg amputee, especially a bilateral amputee, their balance at the surface is often poor, they tip forward, backwards and from side to side. This is often to do with weighting but also the fact that they do not have legs to weigh them down or to balance them.  They also are often unaware of where their stumps (the term for the part of the limb remaining) are, and their stumps come up at right angles to their body.  We have exercises to make amputees aware of this.

Those with paraplegia adopt a different stance, often they are upright in the water and their legs trail down, even when in trim their legs hang below the rest of their body.  The team needs to ensure that the diver is properly weighted and that the horizontal position in the water in reinforced.  Spatial awareness also needs to be created in the diver so that their legs and feet do not drag along the bottom or come into contact with coral.  They need to become aware of where their legs and feet are in the water.

This was very hard for Corey and I was quite honest that he needed to improve considerably and learn to dive properly before I would allow him to move forward. He was gutted but up for the challenge, and what we saw over the next few days was a man committed to succeed!

Michael and Keiron

So back to the pool with Oatsie and Michael. We went through all the skills for RAID OW20 twice and focussed on buoyancy, performing the skills neutrally buoyant, getting Corey in trim and teaching him how to swim underwater without the use of his legs.  It is a pity that Chris Middleton, one of our divemasters and a bilateral amputee had to miss the expedition because of wisdom tooth surgery. Chris is a role model of how to swim underwater without the use of your legs.

Although I, all our Instructors and our DMs/TDMs can demonstrate how to swim underwater, not using your legs and using a modified free diving stroke, it is far better for someone with no legs or no use of their legs to demonstrate the skill.

By the end of the day Corey had progressed substantially and the Red Sea awaited him on Day 4.

Keiron had progressed well with his instructor Moudi and Swars and was getting added value with extra work on advanced buoyancy and SMB and DSMB deployment.

Tomorrow I will talk a little more about our TDMs; we expect very high standards from them.  Michael and the two Toms have over 100 dives each. Michael dived with us in Chuuk Lagoon and both Toms have been on Red Sea liveaboards. We look for them to go beyond DM level and to progress to Instructor level.  Swars had delayed the start of his DM programme, initially because of work and then COVID. He impressed, and here again, veterans have some advantages as they are used to briefings and therefore when you give them a model for a briefing they can quickly pull a high quality briefing together.

RAID Skill Briefing Checklist and OW20 slates

Throughout the week I found the RAID skills briefing slate excellent for the TDMs and the plastic skills slates are a great aide memoire for the whole team.

Find out more about the work of Deptherapy and Deptherapy Education at www.deptherapy.co.uk