Taken from the thread "Re:Nitrox: Why are dives necessary for
certification?" (typos may have been auto corrected in quoted posts)

On Wed, 23 Aug 2000 14:19:55 GMT, Vic wrote:
"How many agencies teach a rescuer to bring a convulsing diver to the
surface? Whilst none of us would want to experience an OxTox fit
underwater, I think we need to recognize that, with the increasing
popularity of nitrox, it will happen. Now almost all the courses I
have seen that cover recovery of a diver don't teach anything about
convulsions - and whilst the risk of drowning is obviously high, the
risk of lung expansion injuries etc. are enormous if the diver is
lifted during the initial stages of the fit. In other words, the
immediate action should be to secure the casualty and do
absolutely nothing else for a while."

On 24 Aug 2000 02:45:44 GMT, js1scuba@aol.comremoveIT (Joel D.
Silverstein) wrote : "Vic, the unconscious diver and the convulsing
diver rescue technique is the same. one needs to wait for the clonic
phase of the convulsion to be over before attempting the rescue "

I replied to both of these comments saying "Bullshit, you bring the
diver up ASAP". I decided to call DAN since I couldn't find anything
to describe seizures or anything support either of our viewpoints.

I spoke to Mr Butler at DAN (1 - 919 - 490 - 2011) and I found what
he said very disturbing. He said that statistics from DAN have shown
that MOST divers who have a seizure on scuba will DIE. Their death is
not related to neuro damage from the seizure, or to complications
caused by the wrong gas mixes, or to pulmonary expansion or to AGE or
to the bends. He said their death is most often caused by drowning
because their buddy or other divers do not know what to do and will
hesitate in bringing them up !!!!!!

When replying to Joel I said... " Why ? Get the person from behind
and start up. The more time you waste playing at depth, the more
problems you end up with. In fact, one could compare a clonic phase
to a panicked diver who is striking out. In addition, not all
seizures even reach a clonic phase. This makes no sense at all."

Please note that DAN does in fact recommend getting the convulsing
victim diver from behind...just as you do with most other victims.

Vic stated.... " Well, your advice differs from that of some others I
have been talking to. For the moment, I shall keep my current view of
things (and look up any references I can find). OK - if the diver has
spit out the reg, I would replace it. But I would still stay at the
same depth whilst doing so."

Please note that DAN recommends that you ascend ASAP with the seizing
diver. I don't know who has told you otherwise but you might want to
ask them to contact DAN. Also please note that DAN says what I told
you about the reg.... don't try to replace it. You aren't going to
be able to replace the reg in a convulsing diver anyway because their
teeth will be tightly clenched.

Mike Gault asked a couple of excellent questions and said that he had
also been told that the diver with a seizure will not be breathing.
Joel and Vic... you didn't give any answers to him. Mr Butler from
DAN agreed with me that the person would be panting for the most part
and not breath-holding. This is why their cause of death is mostly
drowning....they suck in the water.

Scott was very open and perceptive in saying that he had a girlfriend
with a seizure disorder. He said he would never take her diving. He
also said that if he saw someone seizing underwater, he would surface
with them ASAP. Joel and Vic... you didn't answer him either. I
think Scott has seen first hand what neither of you two have... an
actual seizure. The average person doesn't get to see that and let me
tell you, the first time I saw a major seizure when I was in nursing
school, I was frightened. You feel very helpless because you can't
do anything to stop the seizure. You also are afraid that the person
having the seizure is experiencing pain....it looks painful !!!! That
is land-based. Now imagine that underwater. Scott knows this feeling
and he has observed what happens.... he knows that he will surface
with the person ASAP. Scott is a smart man. To wait is just
ridiculous.

Vic and Joel....I'm not sure of your "status" but you speak as
though you might be teaching others or able to review courses. Vic
stated to Joel about the difference between an unconscious diver and a
seizing diver.... "So - that makes the techniques slightly different,
then. With an unconscious diver, you can start the ascent immediately
(and should do so, IMHO). With a fitting diver, to ascend immediately
could well kill the casualty. Now I reckon that should be part of a
rescue course (but AFAIK, it generally isn't)." Vic also
said...."Any thoughts? Do we need to put this into basic rescue
training? "

Gentlemen.......... If you are going to teach ppl about dive rescue,
then you damn well better teach the right shit or you're going to end
up causing more problems !!! As King Jammer would say... and I've
never said this to anyone here.... but for both of you --- STROKE
ALERT. This whole issue is the most important that I've ever argued
about here because we are talking about a very high diver death rate.
Vic said that he thought the incidence of oxtox convulsions was going
to rise because the numbers of divers using mixed gas technology was
rising. Welll... if that is so, and if you two have your head up
your ass, then you will be contributing to the death rate. I don't
want that that....and neither would any responsible diver who needs to
consider what to do if their buddy takes a convulsion.

Do me a favor.... please go back and read what I posted about
seizures. If you can't see it or if you have any questions.... then
please ask me and I will try to help. I'm sure that others in the
medical field could speak about this too...... nydivecon, Dr Harris,
Randy, to name a few that are knowledgeable. ( To those who don't
like nydivecon, lemme just say this : I've never found anything that
he's said about medical stuff to be untrue !!! )

DAN has an article about oxtox that talks a little about rescue for
the convulsing diver. I will C&P some here. Please note that when I
saw some of the quotes, I asked Mr Butler about them because they
seemed contradictory. He said that the article was speaking to FULL
FACE scuba at that point and geared toward the military...which is
what alot of what DAN research is based on and what DAN research helps
out. He said that if you read the part that says "should you ascend
right away or not", you will note that they are talking about the
rescuer having the ability to change the gas content on the victim and
about full face scuba. This is probably where the misinformation is
coming from. If anyone wants me to post the article in it's entirety
please let me know... I will.

In the mean time........ repeat after me, " I WILL SURFACE ASAP WITH
ANY CONVULSING DIVER !!!!!!!!!"

Sent from DAN ------ (note, not entire article here)
------------------------------------------------------------------------------------------
If You Dive Nitrox You Should Know About OXTOX
DAN discusses the dangers of oxygen toxicity
when using nitrox as a breathing gas
By Dr. E.D. Thalmann, DAN Assistant Medical Director;
Captain, Medical Corps, U.S. Navy (retired)

TABLE 3
Symptoms of CNS Oxygen Toxicity
Encountered in NEDU Studies

Convulsions: the most serious symptom and the one to avoid at all
cost.

Definite: muscle twitching, tinnitus (ringing in the ears), blurred or
tunnel vision, disorientation, aphasia (inability to express oneself
by speaking), nystagmus (rapid side-to-side motions of the eye), or
incoordination.

Probable: more equivocal signs which could be due to oxygen toxicity
as well as other causes: light headdress apprehension, dysphoria
(just didn’t feel right), lethargy, and transient nausea.

Recommendations
One thing you should be impressed with by now is that oxygen toxicity
is fickle; convulsions have occurred at shallow depths under
conditions where most experts would not have expected them to occur.

Management of Underwater Convulsion. The following steps should be
taken when treating a convulsing diver:
a. Assume a position behind the convulsing diver. Release the victim’s
weight belt unless he is wearing a drysuit, in which case the weight
belt should be left in place to prevent the diver from assuming a
face-down position on the surface.
b. Leave the victim’s mouthpiece in his mouth. If it is not in his
mouth, do not attempt to replace it; however, if time permits, ensure
that the mouthpiece is switched to the surface position.
c. Grasp the victim around his chest above the underwater breathing
apparatus (UBA) or between the UBA and his body. If difficulty is
encountered in gaining control of the victim in this manner, the
rescuer should use the best method possible to obtain control. The UBA
waist or neck strap may be grasped if necessary.
d. Make a controlled ascent to the surface, maintaining a slight
pressure on the diver’s chest to assist exhalation.(see commentary
below)
e. If additional buoyancy is required, activate the victim’s life
jacket. The rescuer should not release his own weight belt or inflate
his own life jacket.
f. Upon reaching the surface, inflate the victim’s life jacket if not
previously done.
g. Remove the victim’s mouthpiece and switch the valve to SURFACE to
prevent the possibility of the rig flooding and weighing down the
victim.
h. Signal for emergency pick-up.
I. Once the convulsion has subsided, open the victim’s airway by
tilting his head back slightly.
j. Ensure the victim is breathing. Mouth-to-mouth breathing may be
initiated if necessary.
k. If an upward excursion occurred during the actual convulsion,
transport to the nearest chamber and have the victim evaluated by an
individual trained to recognize and treat diving-related illness.

Deciding whether to ascend with a diver who is convulsing can be
tricky. In section 8-2.4 of Volume 1 of the U.S. Navy diving manual it
states:
If a diver convulses, the UBA should be ventilated immediately with a
gas of lower oxygen content, if possible. If depth control is possible
and gas supply is secure (helmet or full face mask), the diver’s depth
should be kept constant until the convulsion subsides. If an ascent
must take place, it should be done as slowly as possible. If a diver
surfaces unconscious because of an oxygen convulsion or to avoid
drowning, the diver must be treated as if suffering from arterial gas
embolism.

With the advent of closed-circuit oxygen rebreathers, the U.S. Navy no
longer uses nitrox scuba and no longer publishes nitrox exposure