What Can Medical Simulation Learn from Scuba Diving?
Recreational scuba diving provides us an amazing opportunity to explore the world’s sea life up to a maximum depth of 120 feet. While hundreds of thousands of people enjoy scuba diving safely every-day all around the globe, the sport is not without serious risks. Decompression sickness, narcosis, wildlife dangers and suffocation are all moments away for individuals who do not adhere to strict guidelines and procedures taught by professional societies such as PADI, SSI or Naui.
Last week my girlfriend Jackie and I traveled to Roatan, an island off the coast of Honduras for a scuba-diving adventure. We spent several days diving anywhere from 35 to 103 feet in warm 85 degree water to experience amazing sea life on the coral reef including thousands of species of fish, sting-rays, jellyfish, lobsters, crabs, sharks and even an octopus! As a certified PADI Rescue Diver, I have accomplished dozens of dives in open ocean-water environments before… but as a new diver who had only recently completed her Advanced Open Water training in the lakes near Las Vegas, these off-shore boat dives offered some new challenges for Jackie.
For example, in Kingman Wash of Lake Mead, if Jackie had overweighted herself and sunk to the bottom during her open water training course the maximum depth of our area was 25 feet – which has little health ramifications. In Roatan, however, if she had lost the same control she could have easily hit 120+ feet which is dangerous because 1) compressed air at that depth means she has much less oxygen than at 25 feet and 2) anything over 130 feet requires several ‘decompression’ stops back up to the surface to prevent ‘decompression illness’ which could require more air than she has available on her back. While new divers like Jackie can appreciate these lessons theoretically from the book or after imaging that the lake’s 25 feet bottom was 125 feet, it is a much different experience to look down after jumping into the water from the boat and not being able to see the ocean’s floor. As with healthcare education and training, nothing can prepare us for the real thing like the real thing. But that being said, “leveling up” to that phase of the training through book work, classroom reviews, multiple choice exams, pool training, and lake diving provided Jackie with enough grounded experiences to prepare her for this first ‘ocean’ journey.
Click the link below to read on and learn how professional diving groups have created certified training programs which rely heavily on simulation to provide novice adventurers with the tools necessary to enjoy the world’s oceans safely and successfully – and what our medical simulation community can learn from scuba diving.
Let’s explore further how professional societies like PADI train us to become certified in safe-diving experiences. After reading a 250 page manual, learners answer 5 knowledge review quizes which are then gone over during a five hour class. During this classroom session topics such as diver safety, gear, hand signals, nitrogen levels, depth restrictions, buoyancy, and more are covered. Learners are instructed on the theories of diving and explain what skill sets will be practiced in the pool. Next, learners spend a full day in a pool with a maximum depth of 14-feet.
The pool is the learner’s “simulated” open-water environment
After learning how to properly setup their gear learners start their first pool session. To begin their simulated experience, learners kneel in the shallow end of the pool and practice removing and ‘clearing’ (the process of expelling water) their masks and finding their air regulator if it comes out of their mouth. Of course in this low-fidelity skill situation there is almost no danger that the learner will drown as they are able to simply “stand up”. Throughout the rest of the day, learners become comfortable practicing more complicated skills such as submerging and descending/ascending safely, using hand signals to indicate low-air to their buddy and “sharing air” from their emergency regulator. Each skill must be demonstrated precisely to the instructor at depth to be “checked off”.
For the next two days, divers are taken to an “open water” location which could be a lake or an ocean. During this weekend, divers are required to repeat the same skill-sets demonstrated in the pool. Some might ask then “why not just skip the pool training and complete the skills education with an additional day at the open water location?”. Consider these additional factors which allow learners and their instructors to specifically focus on the skills they need to be safe:
- is smaller and provides instructors with more physical control over new divers.
- is temperature controlled whereas open water locations can be as low as 47 degrees, making learning or practicing new skills much more difficult.
- does not have a current which could take the novice learner away unexpectedly.
- is very shallow compared to open-water environments which can psychologically overwhelm a new diver.
- has limited depth which means emergency rapid ascension to the surface cannot inflict much damage due to over-expanded lungs.
- has multiple exit points whereas an open water location may only have one, and is usually closer to EMS systems.
- does not have additional sea-life which could be poisonous or otherwise dangerous.
- has boring concrete walls which offer little distraction to new divers compared to exciting open-water environments.
- is not salt-water based which can add additional buoyancy making tasks harder to accomplish.
- can have controlled lighting installed or be in-doors and thus not affected by rapid weather changes.