Keep Calm, and Be Prepared



It was a beautiful summer day, and I was gearing up for a pool session with a family of three. While chatting about the family's future vacation to Hawaii, we were all smiling and laughing. As a new open-water scuba instructor, I was as excited as they were as we arrived at the pool to begin our first day of confined-water training.

We set up our gear, donned our wetsuits and entered the cool water. As we completed each confined-water session, we took a short break on the deck to grab some water and snacks and enjoy the beautiful day.

While getting back in the water for our next session, we noticed a few bees in the area. We waved them off as a nuisance and continued with our training. After 15 or 20 minutes underwater, we surfaced and saw a swarm of bees near the deep end of the pool. The mother was anxious and said she was allergic to bees. I decided to halt the pool session and directed the students to calmly but swiftly remove their gear and exit the water. While I was assisting the mother in removing her gear, she exclaimed, "Ouch!" She had been stung on the back of her neck.

After getting her from the water into a shaded area away from the pool deck, I noticed as I helped her remove her wetsuit that her neck was red and swollen. She said she was having trouble breathing, and I asked her if she had her EpiPen. She did, so I directed her husband to retrieve it from her purse while I calmly had her take slow, deep breaths. I retrieved my first aid bag and cellphone and activated my emergency action plan (EAP), calling my store manager to notify him of the situation and ask him to bring the oxygen unit.

As

Even a common occurrence such as a bee sting can quickly become an
emergency that requires a response from a trained provider.
I called 911, the husband returned with the EpiPen. I handed the phone to the husband, who reported the situation to the 911 operator. I removed the pen from the case, confirmed the pen for name, date and medication and asked the woman if she could administer the injection herself. She shook her head no, so I removed the safety cap from the pen and assisted her with the injection to her outer thigh. Time seemed to stop for the 10 seconds that we both held the pen in place.

The husband reported to the operator that we had administered an EpiPen injection as he and his teenage daughter watched intently. It seemed like we all held our breath to see if the injection would be effective. I looked at the daughter and saw her frozen facial expression, so I reassured her and reminded her to breathe. After the 10 seconds passed, I removed the pen, wrapped it inside a towel and placed it next to my first aid bag.

I continued to assess the patient while listening as the husband answered questions from the 911 operator. He said that this was the second time she was stung this summer, and the reactions were becoming worse with each sting. Almost immediately after the injection, the wife was breathing more comfortably and beginning to talk. The husband breathed a sigh of relief and hugged his daughter.

I took over the phone call and reported to the operator that the patient was now breathing easier. She complained that the sting was causing throbbing pain, and the 911 operator told us that an ambulance was on the way to our location and provided me with a few more instructions before hanging up.

I sat with the woman as her husband and daughter gathered their personal belongings. She was thankful for my quick thinking, and I asked her if I could follow up with her later to see how she was doing. She got into the car and left for the hospital. For the next hour, I cleaned up the deck and documented the situation.

A few hours later I received a call from the husband. He reported that the hospital visit was quick, and the physician assessed her breathing and the sting area. The husband thanked me for my attitude throughout the situation. He said his daughter was especially thankful, attributing my calm and collected behavior to her being able to take the situation in stride. She didn't panic because she didn't see me panicked.

We had covered incidents like this during my instructor training but hadn't elaborated on it. Since it was a dive class, we talked more about marine life injuries and illness than an environmental injury. I wanted to learn more following my instructor training and took the DAN Diving Emergency Management Provider (DEMP) program. This course was more comprehensive, and the instructor provided scenarios that broadened my knowledge beyond water-based incidents.

Because of my DEMP training, I was able to quickly identify that my dive student was experiencing an anaphylactic emergency, and I immediately activated my EAP. Frequently practicing skills and scenarios outside of dive-related emergencies helped me keep this event from becoming something much worse.

© Alert Diver — Q1 2020