&EPA
              United States
              Environmental Protection
              Agency
Gulf Breeze, Florida
        May 1991
              Diver Training  Curriculum
                                     Prepared by
                                     JAMES M. PATRICK, Director, EPA Diver Training
                                     DON LAWHORN, Chairman, EPA Diving Safety Board
                                     DICK RUTKOWSKI, Hyperbarics International
                                     NOAA Diving Office
                                     EPA, Safety, Health, and Environmental
                                     Management Division

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                                             1   I /
                                               LIBRARY COPY
DIVER TRAINING CURRICULUM
                     by
         JAMES M. PATRICK, JR.
         Director, EPA Diver Training
         U.S. EPA Environmental Research Laboratory
         Gulf Breeze, FL 32561
         DONALD LAWHORN
         Chairman, EPA Diving Safety Board
         College Station Road
         Athens, GA 30613-7799
         DICK RUTKOWSKI
         President, Hyperbarics International, Inc.
         490 Caribbean Drive
         Key Largo, FL 33037
         NOAA Diving Office
         Rockville, Maryland and
         Seattle, Washington
         EPA, Division of Safety, Health,
         and Environmental Management
         Washineton, D.C.
         Environmental Research Laboratory
         Office of Research and Development
         U.S. Environmental Protection Agency
         Gulf Breeze, FL 32561
                PROPERTY OF
       ENVIRONMENTAL PROTECTION AGENCY

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DISCLAIMER
                          The information described in this manual has not been
                          subjected to Agency review and is intended to be used as
                          an instructor/student guide during the EPA Diver Training
                          Course. Mention of trade names or commercial products
                          does not constitute endorsement or recommendation
                          for use.
                          James M. Patrick
                          Director, EPA Diver Training

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EPA DIVING
TRAINING CURRICULUM
              VARIABLE-VOLUME DRY SUIT

              DIVING ACCIDENT MANAGEMENT

              DIVER RESCUE

              OPERATIONAL/WORKING DIVER

              CONTAMINATED WATER DIVING

              DIVEMASTER

              NOAA NITROX I AND II

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CONTRIBUTORS
                            Bruce Reynolds
                            U.S. EPA
                            Environmental Research
                            Laboratory
                            27 Tarzwell Drive
                            Narragansett, RI 02882
                            Duane W. Kama
                            U.S. EPA, Region 10
                            1200 6th Avenue
                            Seattle, WA 98101
                            Jonathan Amson
                            OMED, WH-556F
                            U.S. EPA
                            401 M Street, S.W.
                            Washington, D.C. 20460
                            David W. Charters
                            EPA/ERT(MS101)
                            2890 Woodbridge Avenue
                            Edison, NJ OS832
Walter Nied
EPA Region 5
230 S. Dearborn
Chicago, IL 60604
Ed McLean
U.S. EPA
OMEP/MOD WH-556F
Washington, D.C. 20460
David Scott Smith
Acting Deputy Director
U.S. EPA
Safety, Health, and Environ-
mental Management Division
401 M Street, S.W.
Washington, D.C. 20460
                                         IV

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ACKNOWLEDGEMENT
                         The material contained in this manual was compiled with
                         assistance of many valuable suggestions from the NOAA
                         Diving Office staff.
                         Julius C. Jimeno, Director and Patricia Cox of the EPA
                         Safety, Health and Environmental Management Division
                         provided funds for the Diving Accident Management/
                         Operational Diver Training Program.

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CURRICULUM
OUTLINE FOR
EPA DIVING PROGRAM
Program Purpose:
The purpose of this curriculum is to instruct the Environmental
Protection Agency (EPA) and other visiting divers in the use of vari-
able-volume dry suit, diving accident management, contaminated
water awareness, operational/working diver, divemaster, and NOAA
NITROX I and II. These instructional techniques apply to Under-
water Breathing Apparatus (UBA) to be used with Self-Contained
Underwater Breathing Apparatus (SCUBA) and surface supplied air
equipment in accordance with EPA Directives.
Program Objective:
The objective is to ensure that each diver can safely use the UBA in ac-
cordance with the EPA Diving Directives, return to his/her unit and per-
form working dives. Divers must have a good working knowledge of the
equipment used in the course and Limitations in accomplishing working
dives. The program will aid in establishing guidelines used in con-
taminated water diving and diving accident management.
Any candidate who does not meet requirements of this outline will be
dropped from the EPA Diving Program or be reverted to a trainee diver.
In trainee diver status, divers are not allowed to perform working dives.
Program Equipment:
All participants should bring all diving equipment from their unit, as
listed in this Program Outline. Participants who cannot bring the
proper diver's dress should notify the Course Director and other
arrangements will be made.
Equipment which should be brought by the participant from their unit
includes: regulator, underwater pressure gauge, knife, watch, mask,
wet suit, fins, snorkel, compass, depth gauge, gear bag, 30 Ibs. of
weight, weight belt, and back pack. SCUBA tanks are normally
furnished by the Diving Program.
Medical Examinations/
Qualifications:
All participants must show proof of meeting the qualifications as out-
lined in the EPA Diving Directives. All participants, through their
Unit Diving Officer must submit their medical records and diving
qualification to the EPA Diving Officer before the course begins.
Any participant whose records are not in order will not be allowed in
the water without the approval of the EPA Diving Officer and or the
EPA Divine Medical Review Board.
                                             VI

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VARIABLE-VOLUME



DRY SUIT
       Page 1

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VARIABLE-VOLUME
DRY SUIT DIVER
TRAINING PROGRAM
(Course Outline Only)
Note:                       This is a course outline for instructors and team leaders, divemasters
                            and divers.
Purpose:                    The purpose of this program is to teach all participants the principles,
                            applications and use of the variable-volume dry suit.
Objective:                   The objective of this program is to ensure that the participants are
                            qualified in the use of variable-volume dry suits in accordance with
                            the NOAA/EPA Diving Directives.
Qualifications:               Participants must be qualified for scuba diving in accordance with
                            the EPA Diving Directives and be recommended by their unit diving
                            officer, through the EPA Diving Safety Board.
                                       Pace 2

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OPERATIONAL
CONTAMINATED WATER
DIVER TRAINING
COURSE OUTLINE
FIRST DAY:
0800-0830
Classroom
INTRODUCTION
1.     Program
2.     Facilities
3.     Instructors/team leaders
4.     Registration
5.     Review of diving qualifications, medicals, etc.
6.     Team selection
7.     Transportation, hotels, etc.
8.     Inventory of student diving equipment
0830-1000
Classroom
HYPOTHERMIA/HYPERTHERMIA
1.     Body core temperature changes and their physiological effects
2.     Heat transfer
      a.     Conduction
      b.     Convection
      c.     Radiation
3.     Prevention of heat loss in cold water
4.     Prevention of over-heating
5.     Restoring body heat in hypothermia
6.     Lowering body temperature in hyperthermia
7.     Decompression tables and cold-water diving
8.     Missed decompression procedures
9.     Blowup decompression procedures
10.    Polluted water divine
                                      Pace 3

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THE VARIABLE-VOLUME DRY SUIT
1.      Purpose of the dry suit
2.      Pros/cons of Viking vs. other variable-volume dry suits
3.      Preparing the dry suit for diving:
       a.      Inspection procedures for holes, etc.
       b.      Inspection and care of the zipper
       c.      Check on inlet/outlet valves
       d.      Care of the neck seal and cuffs
       e.      Operation, care and inspection of inflation hose
       f.      Repairing the suit
       g.      Proper fit and its importance
       h.      Lubrication of neck seal and cuffs before entry
       i.      Mobility in the dry suits
       j.      Cleaning of the suit after normal use
       k.      Disinfecting washdown of polluted water dive
DANGERS OF USING DRY SUITS
1.      Blowups — how they can occur and contribute to embolism:
       a.      Air in the legs when inverted
       b.      Dropping of the weight belt
       c.      Using the dry suit as a lift bag
       d.      Stuck inlet, inflator hose/valve
       e.      BC fully inflated preventing access to purge valve
       f.      Nonfunctioning purge valve
2.      Holes in upper portion of dry suit and loss of buoyancy
3.      Diver in inverted position due to air in legs
4.      Out of air and difficulty in maintaining buoyancy
5.      Suit too large and loss of fins due to air in feet
6.      Suit too tight
             Pace 4

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BLOW UP PREVENTION AND RECOVERY METHODS
1.      Don't use the variable-volume suit as a lift bag
2.      Ensure adequate training in use of the dry  suit
3.      Know emergency venting procedures:
       a.     Neck seal
       b.     Wrist
       c.     Purge valve
       d.     Flare-outs to slow ascent
4.      Don't use BC over purge and inlet valves
5.      Use shoulder harness or other means of holding weight belt in
       place, especially with weak buckJes
WEIGHT BELTS
1.      Use of a heavily weighted scuba weight belt and problems
       (buckles not holding)
2.      The pros and cons of using harnesses on weight belts or
       using commercial-type belts with harnesses
3.      The use of weights: types, sizes, and how to place them
       for best position in the water
4.      Dangers of dropping weight belts (blowups)
5.      Weighing for the dive and check buoyancy
ANKLE WEIGHTS
1.     Keep feet down helping to prevent inverted blowup
2.     Allow for more air in legs, keeping lower half of the diver warmer
3.     Some weight retained if weight belt is lost
4.     Help to keep feet in boots of dry suit if diver gets inverted
5.     Make swimming harder, especially long distances
FIN STRAPS
Help to keep fins on when jumping into water or when diver gets into
inverted position and air gets into legs.
             Pace 5

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NECK SEAL
1.      Proper fit for good seal around the neck
2.      How to wear the seal
3.      Lubrication and ease of donning
4.      Venting suit through neck seal
5.      Leaks caused by long hair
6.      Advantages of neck seals in surface-supplied diving
HOODS
1.     Possible external squeeze
2.     Problems associated with air in hood on ascent
3.     Elimination of air in hood with a hole
4.     Care of hood and seal
5.     Long hair and problems associated with leaks
6.     Problems of leaks due to overlapping of hood and mask
7.     Venting from  hood and neck seal
AIR INLET VALVE
1.      Proper use for buoyancy control (ascent/descent)
2.      Cleaning and inspecting before dive
3.      Dangers involved with stuck inlet valve
4.      Quick-connect to air hose and its function
5.      Problems if quick-connect becomes loose under water
AIR OUTLET VALVE (PURGE)
1.      Proper use (ascent/descent)
2.      Cleaning, inspecting and lubricating
3.      Stuck purge valve
4.      Leakv valve
               oe 6

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AIR HOSE
1.      Proper type and fit
2.      Purpose
3.      Quick-connect
4.      Adapting hose to the first stage:
       a.      U.S. models must use an adaptor with Teflon
              set to change from metric thread
       b.      A "T" swivel might be needed if only one
              low-pressure port on first stage
       c.      A new modification-type hose is used to
              prevent fitting from  coming off at depth
       d.      Quick-connect is cleaned and lubricated for
              proper operation
AIR IN SUIT
1.     Insulation for warmth
2.     Buoyancy control
3.     Changes in buoyancy due to depth
4.     Blowups (inverted/upright)
UNDERWEAR
1.      Types, purposes and insulation qualities
2.      Additional weight with additional underwear
CUFFS
1.      Importance of proper fit
2.      Venting from cuffs
3.      Lubrication
4.      Repair
5.      Type of material
             Pace?

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                                ZIPPER
                                1.      Care and lubrication of zipper
                                FINS
                                1.     Types of dry suits
                                2.     Proper fit
                                3.     Shoe and suit interface problems
                                4.     Fin straps and their importance
                                5.     Dangers of losing fins:
                                      a.      When jumping into water
                                      b.      When diver is in inverted position
1000-1030
Classroom                      FILM, 20 MIN., TV, VIDEO, B&W
                                (This film demonstrates the normal and emergency
                                functions of the Unisuit)
                                1.     Ascending/descending, using air inlet valve and
                                      purge valve with controlled conditions
                                2.     Descending without letting air into the  dry suit
                                      (this demonstrates suit squeeze in all portions of the body)
                                3.     Inverted diver with air in legs attempting to right himself
                                4.     Venting from the wrists
                                5.     Swimming without weight belt
                                6.     Venting from the neck seal
                                7.     Barrel roll showing movement of air in suit
                                8.     Adding air, becoming positive, and venting
                                      from wrist, neck, and/or purge
                                9.     Inverted diver drops weight belt, corrects position,
                                      and controls buoyancy to the surface
                                10.    Dropping weight belt and
                                      controlled breathing ascent to surface
                                11.    Descending without weight belt
                                12.    Shoulder-harness-type weight demonstration
                                      (with buckles and velcro) — the pros and cons
                                      of shoulder harness use
                                            Pace 8

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1030-1130
Classroom                      SUIT SELECTION (CHECK FOR FIT) INVENTORY
                                1.     Each student is fitted with a suit for the duration of the program
                                2.     Suits are checked by students for leaks
                                3.     Suits repaired as needed
                                4.     Each student is issued an air inlet hose
                                5.     Students attach air inlet hose to first stage to ensure
                                       proper threads from U.S. to metric
                                6.     Each student is issued fin straps
                                ACCESSORIES
                                1.      Weighted shoes for stability
                                2.      Rubbers or galoshes for protection
                                3.      Gloves:   types, insulation values, and duration of use
                                       in cold water for each type
                                4.      Under-gloves for added insulation
                                5.      Full-face mask  for added warmth/communications
                                6.      Hats, pots and/or helmets and how they can be mated
                                       to the dry suit
                                       a.      Neck seal,  hat, pot, and/or helmet not attached
                                       b.      Neck ring, hat, pot, and/or helmet attached
                                7.      Mixed gas diving and different heating values
                                8.      Coveralls:    types, reasons for wearing, etc.
                                9.      Cleaning, storing and/or hanging the dry suit
1130-1300                      LUNCH
                                             Pace 9

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1300-1355
Pool (Shallow End)             DRY SUIT CHECKOUTS
                                1.      Program instructor demonstrates getting into
                                       and out of dry suit
                                2.      All students prepare their suits for diving
                                       a.      Set up dive stations with team leader/buddy
                                       b.      Set up scuba tank and regulator
                                       c.      Lubricate dry suit, cuffs, neck seal,
                                              and zipper as needed
                                3.      Students dress in dry suit
                                4.      Students checked by instructor for:
                                       a.      Proper fit
                                       b.      Proper equipment
                                       c.      Proper connections of air hose to regulator and suit
                                       d.      Proper type, fit and weight on weight belt
                                       e.      Proper fins and fit with fin straps
                                5.      Students enter shallow end of pool for self-checkout of:
                                       a.      Suit buoyancy with and without weights
                                       b.      Use of air inlet valve and purge valve
                                       c.      Ascent and descent with use of air inlet and
                                              purge valves, and proper position for use
                                       d.      Getting  into inverted position, air in legs
                                       e.      Swimming with  and without ankle weights
                                       f.      Mobility in suit
                                       g.      Venting from wrists and neck seal
                                       h.      Swimming with  and without weight belt
                                       i.      Barrel rolls
                                       j       Removal of face mask and work with hood seal
                                             Pace 10

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Pool
(Deep End)                    DRY SUIT CHECKOUTS
                               1.      Students enter deep end of pool for self-checkout of dry suit:
                                      a.      Perform exercises in item 5 above
                                      b      Check suit squeeze
                                      c.      Controlled ascents and non-controlled ascents
1630-1700                     SECURE FROM POOL ACTIVITIES
                               1.      Undress and secure diving dress and equipment
                               2.      Report to team leader for debriefing
                               3.      Report defective equipment and repairs needed
SECOND DAY
0800-0845                      1.      Homework review (physics/physiology)
                               2.      Question and answer period
                               3.      Debriefing of previous day's water work by team leaders
                               4.      Briefing and schedules for day's program
0845-1000                     1.     Diving Accident Management
                                      a.      Pressure
                                             i)      ATA, FSW and PS1
                                      b.      Physics
                                             i)     Dalton'sLaw(P = Pi + P2 + P3... etc.)
                                             ii)     Partial pressure of gases
                                      c.      Boyle's Law
                                             i)     Pressure vs. Volume
                                             ii)      Pressure vs. Diameter
                                      d.      Boyle's Law as related to the skin diver (breath holding)
                                      e.      Boyle's Law as related to scuba diving and
                                             breathing under pressure
                                           Pace 11

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1000-1015                     BREAK
1015-1100                     1.      Extra Alveolar Air
                                     a.     Physics
                                     b.     Physiology
                                     c.     Pathophysiology of:
                                           i.     Arterial Gas Embolism
                                           ii.    Pneumothorax
                                           iii.    Pneumopericardium
                                           iv.    Pneumomediastinum
1100-1145                     TEAM BRIEFING FOR AFTERNOON WATER WORK
1145-1300                     LUNCH
1300-1600                     TEAM LEADERS ORGANIZE TEAMS AND
Open Water                   DIVE STATIONS/SITES
                              1.      Teams report to the dive site
                              2.      Leaders brief teams on their respective dive projects
                              3.      Teams set up dive stations, check all gear, and work with
                                     buddy to ensure he has all gear and understands the dive plan
                              4.      Dive teams dress  in dry suits
                              5.      Buddies check each other, review dive plan and tables
                              6.      Team leaders check each dive team
                              7.      Divemaster and/or safety diver check each diver
                              8.      Divemaster/team  leader ensure diving accident management
                                     emergency plan is in effect
                              9.      Teams check out  with divemaster and enter water
                                         Pace 12

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Purpose (Dive Plan)             The purpose of this dive is to let students become familiar with their
                                diving dress (dry suits) for the first time in open-water conditions.
                                Diver will work with team leader and/or divemaster and demonstrate
                                performance of all normal and emergency procedures as practiced in
                                the pool the previous day. The rate of advancement through these ex-
                                ercises will  be determined by the instructor. Students who do not
                                show proficiency will remain one-on-one with the team leader until
                                proficiency is demonstrated. This will allow students to move to the
                                next part of the training program (working with another student). The
                                rate of advancement through these exercises is determined by the in-
                                structor/team leader.
                                The team leader/instructor will ensure that dive area is cleared for
                                diving in accordance with the EPA Diving Directives. The diving ac-
                                cident management emergency plan must be in effect and understood
                                by all involved,  in accordance with the EPA Diving Directives and
                                the EPA Diving Accident Management manual.
                                The students will use all dry suit techniques as employed in  the pre-
                                vious days' pool session. The afternoon session will use ascend-
                                ing/descending lines to contro'l rates, but will make excursions using
                                buddy lines and diver-to-surface lines. While making these excursion
                                in limited visibility, divers will use a compass. The tending diver on
                                the surface will signal divers below with the line-pull signals when
                                he/she wants them to come up for any reason
                                A diving safety boat must be in the water in case of diving emergen-
                                cy, and equipped to handle emergencies in accordance with  EPA
                                Diving Directives. All appropriate clearances must be maintained for
                                diving, and appropriate flags must be flown in accordance with the
                                EPA Diving Directives.
                                SECURE FROM DIVING OPERATIONS
                                1.     Secure diving projects
                                2.     Secure diving accident management network
                                3.     Inform all appropriate authorities that diving operations are
                                       secured, remove diving flags
                                4.     Secure diving equipment, undress, and clean all gear

                                5.     Debriefing by team leader
1600-1630                      BREAK
                                            Page 13

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1630-1800                      CONTINUE DIVING ACCIDENT
                               MANAGEMENT/RESCUE FOR E.A.A.
                               1.     Prevention of diving accidents (E.A.A.)
                                     a.     Medical Causes
                                     b.     Operational
                                     c.     Environmental
                               2.     Early recognition of signs/symptoms of E.A.A.
                               3.     First aid of diving accident
                                     a.     Use of oxygen and its importance, medical
                                            implications and pathophysiology
                                     b.     Protection of airway and vital signs
                                     c.     Oxygen safety
                                     d.     Oxygen delivery systems

THIRD DAY
0800-0845                      HOMEWORK REVIEW (Physics/Physiology III)
0845-0900                      TEAM LEADER REVIEW SESSION
0845-1000                      MAN AND HIS NEW ENVIRONMENT
                               Acclimation to mean sea level
                               Ascending to lesser pressure (hypobaric conditions)
                               Descending to higher pressures (hyperbaric conditions)
                               Ascending/descending in unpressurized conditions
                               Controlling physiological parameters within the body, under varying
                               pressures
                               Barotrauma (direct effects of pressure) and the semi-rigid spaces in
                               the body and how they are affected
                               Indirect effects of pressure
                               (decompression sickness and density of gases)
                                     a)     Inward/outward gradient of inert gases from the body
                                            and importance of keeping it in balance
                                           Pace 14

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Note:                          Divers attending this program should fully understand the physics,
                               physiology and medical aspects of decompression sickness. The lec-
                               ture above is a quick review, especially for non-divers, of the basic
                               physics/physiology of diving.

                               MEDICAL ASPECTS (Signs/Symptoms)
                               1.     Decompression sickness
                                      a.     How it occurs
                                      b.     Onset times
                                      c.     Post dive early recognition of mild/severe signs
                                             and symptoms
                                      d.     Immediate first aid
                               2.     Examination by physician at chamber
                               3.     Transfer into chamber and related problems
                               4.     Flashback to accident site, showing victim coming to surface
                                      confused, being helped into boat and first aid being
                                      administered. Full narration of procedures as performed
                                      for a conscious and unconscious victim
                               5.     Coast Guard alarm office and their procedures for alerting
                                      flight crews
                               6.     Complete visual display of "bubble trouble", signs/symptoms
                               7.     Complete animated outline of the pathology of
                                       decompression sickness and extra alveolar air

                               REVIEW OF:
                               a.     Importance of oxygen and its pharmacology
                               b.     The Trendelenburg Position/Left Lateral Down
                               c.     Liquids and aspirin and the pharmacology
100-1015                       BREAK
                                            Paee 15

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1015-1100                     DIVING ACCIDENT MANAGEMENT
                               (Manual is used for this lecture as a guideline and
                               for future reference)
                               History of first aid procedures
                               Case history of victim with management in the field and outcome at
                               the chamber
                               Case history of victim with proper first aid and evacuation
                               Review of the diving accident flow chart first aid procedure
                                       a.      Mild symptoms
                                       b.     Severe symptoms
                               Step by step explanation of the flow chart, why and when to give
                               oxygen, and other first aid measures
                               The importance of first aid for early mild symptoms
                                       a.      Fatigue
                                       b.     Weakness
                                       c.      Indifference/personality changes
                                       d.     Skin rash
1100-1200                     INTRODUCTION TO ADVANCED DIVE EQUIPMENT
                               1.     AGA (Use and Service)
                               2.     Wireless Communication
                               3.     Finger Locator
                               4.     Hand pull signals


1200-1300                     LUNCH


1300-1630                     WATER WORK
                               1.     Purpose of day's dive plan: The purpose of this day is for
                                      team leaders to designate divemasters and allow them to su-
                                      pervise a diving operation/project of less qualified divers on
                                      any of the projects designated by the Diving Supervisor. This
                                      might be any project outlined in days one and two of this pro-
                                      gram. Students with lesser qualifications should use these
                                      projects to improve their diving ability and skills.
                                           Page 16

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                               2.     Objectives:

                                      a.     The objective of the above dive plan is to ensure that
                                             each divemaster can supervise diving operations with
                                             less qualified divers, in accordance with the EPA
                                             Diving Directives and this Course Outline. He should
                                             be confident in all emergency situations, make
                                             decisions to avoid accidents, and in the event of an ac-
                                             cident, be able to stabilize the victim and evacuate
                                             him to the hyperbaric trauma system, if needed.
                                      b.     Student divers should be able to perform all working
                                             skills of an EPA working diver, in accordance with
                                             the EPA Diving Directives and this Course Outline.
                                      c.     Previously qualified EPA divers who are in this
                                             course to requalify must demonstrate their skills.
                               3.     Team leaders, diving supervisors, instructors, and
                                      divemasters must observe all subordinates and report their
                                      abilities, particularly if there are any students with abilities
                                      less than the standards outlined in this Course Outline and the
                                      EPA Diving Directives.
                               4.     Any diver whose performance/ability/skill/knowledge upon
                                      completion of this course does not equal that of an EPA work-
                                      ing diver or higher will, upon recommendation of the Course
                                      Director through the EPA Safety Board Chairman, be
                                      dropped from the EPA Diving Program or reverted to an
                                      EPA Trainee Diver.
1300-1630                     WATER WORK
                               TEAM BRIEFING BY DIVEMASTER TRAINEE,
                               SUPERVISED BY INSTRUCTOR
                               1.     Team leader/instructor/divemaster selection

                               2.     Team selection and other surface support personnel
                               3.     Hyperbaric accident trauma network requirements:
                                      a.     Emergency phone numbers
                                      b.     Money for emergency phone calls
                                      c.     Call or visit to chamber complex
                                      d.     Verification that local paramedics know dive site,
                                             where  chamber is located, and diving accident/first
                                             aid procedures


                                           Page 17

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                                       e.      Communication channels/frequencies
                                       f.      Mechanical resuscitative equipment at site
                                       g.      Oxygen supply at dive site (enough to transport
                                              patient to chamber complex)
                                4.      Small boats as needed
                                5.      Plan to remove injured diver out of water
                                6.      Surface support personnel (standby/safety diver)
                                7.      Secure dive site for diving operations:
                                       a.      Notification of proper authorities: harbor, Coast
                                              Guard, etc., to ensure safe diving operations
                                8.      Diving flags on shore/floats, as needed
                                9.      Safe ship dive check-off sheet, if working under boats or
                                       docks in immediate area, to ensure that they have no
                                       electronic equipment operating that could be harmful to
                                       divers (pingers, sonar, etc.), even though diving operations
                                       might not be under ships '
                                10.     Dive projects as directed by Diving Instructor,

                                        Dry Suits
                                        Surface Supply Diving
                                        U/W Communications (Wireless, Hard Wire, Hand Signals,
                                        Diver Recall Systems)
                                        Search and Recovery Procedures
                                        Underwater Tools (Flange)
                                        Underwater Metal Detectors
                                        Active/Passive Pinger Locators
                                        Underwater Cutting (Mapp Gas)
                                        Nitrox I and II
                                Teams will be assigned projects as directed by EPA Diving Instructors.
1630-1700                      Debriefing by Diving Instructors
                                Fill in dive log
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1700-1800                      The importance of first aid, stabilization and evacuation for severe
                                signs/symptoms
                                       a.     Joint pains
                                       b.     Dizziness/visual disturbances
                                       c.     Paralysis of face, limbs or extremities
                                       d.     Feeling of blow on chest/chest pain
                                       e.     Shortness of breath
                                       f.     Severe hacking cough/bloody, frothy mouth
                                       g.     Staggering/difficulty telling direction
                                       h.     Convulsions
                                       i.     Collapse or unconsciousness
                                       j      Cessation of breathing and/or pulse
                                Importance of knowing location of nearest hyperbaric trauma center
                                and how to evacuate victim
                                       a.     Availability of hyperbaric physician
                                       b.     Availability and location of multi-place, multi-lock
                                              recompression chamber
                                       c.     Methods of evacuation (air/land)
                                       d.     Communication (phone/radio)
                                Importance of qualification in first aid procedures and CPR
                                Importance of emergency medical equipment at site
                                       a.     Oxygen, type, supply and delivery system
                                       b.     Neurological base line equipment
                                       c.     Complete first aid kit for diver/marine use
                                       d.     Fluids (oral/I.V.), I.V by qualified persons only
                                       e.     Aspirin, Afrin, etc.
                                Emergency evacuation  procedures for paramedics, physicians and
                                flight crews. The importance of their knowing these procedures
                                before beginning evacuation.
                                       a.     Maintain breathing and heart functions, ensure
                                              airway is open and remains open
                                       b.     Supply  oxygen to patient in transport, pros/cons of
                                              the Trendelenburg Position/Left Lateral Down
                                       c.     Ensure paramedics/physicians understand why diving
                                              accident victims must be taken directly to recompression
                                              chamber facility instead of to a hospital
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d.
                                               Ensure they understand why patient must be kept on
                                               oxygen (unless convulsions occur). Without oxygen,
                                               bubbles will reload with nitrogen and worsen condition.
                                        e.      Keep patient out of hot sun and monitor for shock
                                        f.      Do not give pain killing drugs. I.V.'s can  be started to
                                               prevent vascular collapse or dehydration (plain lac-
                                               tated ringers is I.V. of choice: otherwise, D5LR or
                                               DI/2NS). Two aspirins may be given.
                                        g.      Instruct flight crews to fly or pressurize aircraft below
                                               1000 feet (if no  hazard to aircraft). Pressure as near to
                                               mean sea level is desired
                                        h.      Prepare a complete history of events  leading up to,
                                               and including accident should be forwarded. All first
                                               aid measures taken and any previous medical history
                                               of patient should be forwarded with patient
                                        i.      In the event of a fatality, all diving equipment should
                                               be forwarded to the proper authority
                                 In-water recompression (pros/cons)
                                 1.      In-water recompression should not be attempted:
                                        a.      It loads the bubbles more
                                        b.      Exposure time is too great
                                        c.      Environmental factors subject to change
                                        d.      Pros/cons of in-water treatment with  oxygen
                                        e.      If serious symptoms exist, it is not possible  to put
                                               into water. If mild symptoms, time exists to evacuate
                                        f.      Missed decompression procedures (asymptomatic)
                                 Recompression chamber requirements (35 mm slide presentation of
                                 types/sizes/purposes)
                                 1.      Multi-place, multi-lock, 6 ata

                                 2.      Multi-place, single-lock, 6 ata
                                 3.      Mono-place (single-place), 2 ata
                                 4.      Single-place, 6 ata
                                 5.      Portable, inflatable (PIRC)
NOTE:                          The pros and cons of each type of recompression chamber is dis-
                                 cussed to ensure that diving accident victims requiring hands-on care
                                 and six atmospheres of pressure are sent to the proper facility, in ac-
                                 cordance with the OSHA Regulations.


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Pressure must be sufficient to reduce bubble size (gas embolism
requires 6 atmospheres and even this only reduces the diameter
of the bubble by 52%).

Physicians have no way of getting hands on patient
       a.      To maintain vital signs and monitor patient
       b.      Keep airway clear
       c.      Perform neurological examinations necessary to
              determine proper treatment/reoccurrence of symptoms
       d.      Perform operations such as intubation as needed
       Pulmonary overdistention cases may have air leakage causing
       a tension pneumothorax which requires hands-on care and
       continuous monitoring. Physicians must have the option of
       changing from oxygen to air and/or going deeper than 2
       atmospheres when necessary. Mono-type chambers do not
       have this capability.
       Oxygen convulsions may cause respiratory arrest, close off
       patient's glottis, causing embolism while dropping pressure
       to relieve convulsions
       It is often better to transport victims without putting them into
       a one-lock chamber for the above reasons. Transportation
       using oxygen and Trendelenburg while monitoring vitals is
       often the best way.


COMMUNICATIONS
Ensure participants understand the  importance of
communications to:
       a.      Talk with physician on the beach
       b.     Alert the Coast Guard, if at sea
       c.      Know all important frequencies and numbers
              necessary to make a medical evacuation in U.S.
              and foreign territories

              i.      Know all frequencies and telephone numbers for
                     contacting shore-based paramedics

              ii.     Know all numbers for recompression chamber
                     facilities and/or physicians attached to them

              iii.     Have copies of international/domestic chamber
                     facilities, USN, Worldwide Hyperbaric Chamber,
                     Shore Based, NAV SHIPS 0994-4011
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                               HELICOPTER EVACUATION PROCEDURES
                               1.     Try to establish communications with the helicopter.
                                      If your boat is unable to, work through another boat if possible
                               2.     Maintain speed of 10 to 15 knots
                               3.     Maintain course into the wind, about 20 degrees on port bow
                               4.     Put all antennas down if possible, while continuing
                                      to maintain communications
                               5.     Secure all loose objects on/around decks
                               6.     Always let the lifting device (stretcher) touch the boat
                                       before handling, to prevent electric shock
                               7.     Place life jacket on patient
                               8.     Tie patient in basket (stretcher) face up
                               9.     If patient cannot communicate, place as much information
                                      about him as possible on note paper and pin to clothes
                                      (age, name, address, medications given, etc.)
                               10.    If patient is a diving accident victim, ensure that flight crew
                                      has a copy of or is instructed in procedures for diving
                                      accidents and will take patient to hyperbaric trauma complex
                                      (chamber)
                               11.    If patient dies, inform flight crew
                               12.    Instruct flight crews to fly as low as possible to prevent
                                      pressure changes and explain why
FOURTH DAY
0800-0845                       Review Homework (Physics/Physiology III)
                                Review previous day's diving project


0845-1000                       OPERATIONAL DIVING
                                1.      Dive planning
                                       a.      Gas physiology (narcosis, DCS and CNS balance)
                                2.      Gas supply requirements
                                3.      Cylinder duration
                                4.      Gas analyzation
                                5.      Compressor safety (lubricants, filters and the lungs)
                                6.      Decompression procedures

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                                7.      Dive safety
                                8.      Contaminated water (diving and equipment)
                                       a.     Type of dress
                                       b.     Decontamination
                                       c.     On-site coordinator
                                       d.     On-site awareness of contaminants
                                       e.     Use of ROV's and other related equipment
1000-1015                      BREAK


1015-1100                      Nitrox diving (NNI and NNII)
                                Physics of nitrox diving
                                Oxygen life support ranges
                                CNS oxygen toxicity
                                Equivalent air depth concept
                                Nitrox decompression tables
                                Oxygen safety


1115-1200                      Advanced equipment briefing
                                Wireless communication systems
                                MAPP Gas cutting
                                Nitrox diving


1200-1300                      LUNCH


1300-1630                      WATER WORK
                                1.     Purpose of day's dive plan: The purpose of this day is for
                                      instructors to designate divemasters and allow them to super-
                                      vise a diving operation/project of less qualified divers on any
                                      of the projects designated by Diving Instructors. This might
                                      be any project outlined in days one and two of this program.
                                      Students with lesser qualifications should use these projects
                                      to improve their diving ability and skills.
                                2.     Objectives:

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                                      a.      The objective of the above dive plan is to ensure that
                                             each divemaster can supervise diving operations with
                                             less qualified divers, in accordance with the EPA
                                             Diving Directives and this Course Outline. He should
                                             be confident in all emergency situations, make
                                             decisions to avoid accidents, and in  the event of an ac-
                                             cident, be able to stabilize the victim and evacuate
                                             him to the hyperbaric trauma system, if needed.
                                      b.      Student divers should be able to perform all working
                                             skills of an EPA working diver, in accordance with
                                             the EPA Diving Directives and this  Course Outline.
                                      c.      Previously qualified EPA divers who are in this
                                             course to requalify must demonstrate their skills.
                               3.     Team leaders, diving supervisors, instructors, and
                                      divemasters must observe all subordinates and report their
                                      abilities, particularly if there are any students with abilities
                                      less than the standards outlined in this Course Outline and the
                                      EPA Diving Directives. .
                               4.     Any diver whose performance/ability/skill/knowiedge upon
                                      completion of this course does not equal that of an EPA work-
                                      ing diver or higher will, upon recommendation of the Course
                                      Director through the EPA Safety  Board Chairman, be
                                      dropped from the EPA Diving Program or reverted to an
                                      EPA Trainee Diver.
1300-1630                      WATER WORK
                               TEAM BRIEFING BY DIVEMASTER TRAINEE, SUPERVISED
                               BY INSTRUCTOR
                               1.     Team leader/instructor/divemaster selection
                               2.     Team selection and other surface support personnel
                               3.     Establish hyperbaric accident trauma network requirements:
                                      a.      Emergency phone numbers
                                      b.      Money for emergency phone calls
                                      c.      Call or visit to chamber complex
                                      d.      Verification that local paramedics know dive site,
                                             and know where chamber is located, and
                                             diving accident/first aid procedures
                                      e.      Communication channels/frequencies

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       f.      Mechanical resuscitative equipment at site
       g.      Oxygen supply at dive site (enough to transport
              patient to chamber complex)
4.      Small boats as needed

5.      Plan to remove injured diver out of water
6.      Surface support personnel (standby/safety diver)
7.      Secure dive site for diving operations:
       a.      Notification of proper authorities: harbor, Coast
              Guard, etc., to ensure safe diving operations
8.      Diving flags on shore/floats, as needed
9.      Safe ship dive check-off sheet if working under boats or
       docks in immediate area, to ensure that they have no
       electronic equipment operating that could be harmful to divers
       (pingers, sonar, etc.), even though diving operations might
       not be under the ships
10.    Dive projects directed by diving instructors:

        Dry Suits
        Surface Supply Diving
        U/W Communications (Wireless, Hard Wire, Hand Signals,
        Diver Recall Systems)
        Search and Recovery Procedures
        Underwater Tools (Flange)
        Underwater Metal Detectors
        Active/Passive Pinger Locators
        Underwater Cutting (Mapp Gas)
        Practical Use of NOAA Nitrox 1 and II
Teams will be assigned projects as directed by the EPA Diving Instructors.

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COURSE MATERIALS
(Manuals/Handouts)
                             (FILMS/SLIDES)
                             a.     Hypothermia
                             b.     Hyperthermia
                             c.     Drysuit Emergency Training Techniques
                             d.     Overview of Diving Accidents
                             e.     Microbial Hazards of Diving
                             f.     Demonstration of NOAA/EPA Contaminated
                                   Diving Protection
                             g.     Contaminated Water EPA Diving Operations
                             h.     Use of ROV's in Contaminated Water by EPA
                                   Emergency Response Team
                             MATERIALS/HANDOUTS
                             a.     Diving Accident Management Manual
                             b.     Instructor/Student Guide to NITROX Use
                             c.     Equipment Innovations Cut Risk for Divers
                             d.     Interim Protocol for Diving Operations in
                                   Contaminated Waters
                             e.     Microbial Hazards of Diving in Polluted Water
                             f.     Compressor, Lubricants, Filters and the Lungs
                             g.     Program Curriculum
                             h.     Dry Suit Diving/Equipment Guidelines
                             i.     Factors That Contribute to the Bends
                             j.     Homework Assignments
                             k.     Nitrox Training Manual
                             1.     USN Divers Handbook
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