Heart Attacks and Strokes are the biggest killers of western males. For this reason it is essential that the Supervisor has a good understanding of these conditions:

Heart attacks and strokes are what kill most middle aged males. Although the majority of the DMT course place a lot of emphasis on traumatic injuries. But all the evidence shows that what is most likely to kill offshore divers is what kills most middle aged males: heart attacks and strokes. 

With a Stroke or Cerebro-Vascular Accident (CVA) it is important to be aware that there are 3 types:

• Thrombotic Stroke (Furred Artery).
• Embolic Stroke (Clot, Fat or Gas) This would include CAGE (Cerebral Arterial Gas Embolism)
• Haemorrhagic Stroke  (Bleed).

There is a classic danger point for the presentation of heart attacks and strokes with regards to divers. When they get out of the water. Therefore great vigilance must be maintained when a diver exits the water. This is particularly evident when a diver is in Saturation and enters the bell after a dive. There are numerous reasons why this is a dangerous time for the diver:

• The diver cardiovascular system is under sudden strain. When the diver exits the water there is a sudden drop in hydrostatic pressure (Systemic Vascular Resistance). There is a measurable drop in blood pressure and cardiac output.
• The diver goes from a fairly weightless environment to suddenly bearing 30kg+ of equipment and having to suddenly exert themselves (sometimes extremely).
• The diver may have just worked 6 hours, and be clinically dehydrated.

All of these risk factors dramatically increase the chance of heart attack or stroke. There is a really strong argument for a period of enforced rest when a diver exits the water. The routine use of a man-lift system of bell flooding to aid a divers passage out of the water. A great DMT avoids  heart attacks or strokes.

• DMT Course Manual. Section 3.5.3.

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