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Important disclaimer
This is general educational information only. Always complete proper first-aid training (EFR, DAN DEMP). In any emergency, call local emergency services immediately. Contact with DAN (Divers Alert Network) is essential in diving emergencies.
First aid
for divers.
Knowing the fundamentals of diver first aid can save lives. This guide covers the most common diving emergencies — and the do's and don'ts of each.
Decompression sickness (DCS)
Decompression sickness occurs when nitrogen dissolved in tissues forms bubbles during an ascent that is too rapid. There are two types: Type I (musculoskeletal, cutaneous) and Type II (neurological, cardiopulmonary).
Symptoms — typically appear within 6 hours:
- Joint or muscle pain ("the bends"), especially shoulders, elbows, and knees
- Extreme fatigue, weakness
- Skin rash, itching, mottling
- Numbness, tingling, paralysis (Type II DCS)
- Difficulty breathing, chest pain
- Nausea, vomiting, vertigo
- Loss of consciousness (critical emergency)
Immediate treatment:
- Call local emergency services and DAN immediately
- Administer 100% oxygen via non-rebreather mask if available
- Keep patient lying down (recovery position if unconscious)
- Hydrate with water if conscious and able to swallow
- NEVER resubmerge the affected diver
- Transport urgently to a hyperbaric chamber
Barotrauma
Barotrauma occurs when air spaces in the body cannot equalize pressure with depth changes. The most common types in diving:
- Middle ear barotrauma: Most common. Ear pain during descent from inability to equalize. Stop descent, ascend slightly, try gentle Valsalva maneuver. If it persists, abort the dive. Never dive with severe nasal congestion.
- Sinus barotrauma: Facial pain during ascent or descent. Treat as ear — stop and equalize. May require medical attention if persistent.
- Pulmonary barotrauma / overexpansion: Most serious type. Occurs when holding breath during ascent. Can lead to pneumothorax or arterial gas embolism (AGE) — a potentially fatal emergency. Symptoms: chest pain, difficulty breathing, coughing blood, neurological symptoms. Treatment: oxygen, urgent medical emergency, hyperbaric chamber.
The golden rule: never hold your breath underwater. Always breathe continuously.
Marine envenomation
Jellyfish
Remove visible tentacles without rubbing (use gloves or card). Rinse with seawater (not fresh water; not vinegar for most species). Very hot water (45°C) may reduce pain. Seek medical attention for severe reactions or potentially lethal species (Physalia, Chironex).
Lionfish / Scorpionfish
Immerse affected area in very hot water (45°C) for 30–90 minutes — heat denatures the protein-based venom. Remove visible spines. Seek medical attention. Risk of secondary infection.
Sea urchins
Do not forcibly extract spines — they break. Soak in hot water. Seek medical attention for professional removal. Calcium spines usually reabsorb; venomous spines from certain species require extraction.
Stingray
Laceration wound + venom. Very hot water (45°C) for the venom. Control bleeding for the wound. Seek urgent medical attention — stingray lacerations are serious and infection-prone. The spine may break off inside the wound.
Near-drowning & emergency oxygen
Near-drowning: Any diver rescued from the water with compromised breathing should be treated as a medical emergency, even if they initially appear fine. Secondary drowning syndrome can develop hours later.
- Call emergency services immediately
- Begin CPR if no breathing and no pulse
- Keep the patient warm (hypothermia is a common complication)
- Administer 100% oxygen if available
- Transport to hospital for observation even if they appear to recover
Emergency oxygen: 100% oxygen is the first-line treatment for almost all diving emergencies — DCS, AGE, near-drowning. Responsible operators and dive boats should have oxygen equipment available and staff trained to use it.
The DAN DEMP course (Dive Emergency Management Provider) teaches correct use of emergency oxygen equipment and is highly recommended for all active divers.
When to call DAN
DAN (Divers Alert Network) operates a 24/7 emergency hotline staffed by physicians specializing in hyperbaric medicine. Contact DAN for:
- Any suspected DCS or AGE
- Any neurological symptoms after diving
- Locating the nearest hyperbaric chamber
- Uncertainty about whether a symptom is diving-related
DAN Americas: +1 (919) 684-9111 (emergencies) · +1 (919) 684-2948 (non-emergency)
DAN Europe: +39 06 4211 5685
DAN Asia-Pacific: +61 8 8212 9242
Consider a DAN dive insurance policy — it covers medical evacuation, hyperbaric chamber treatment, and hospitalization related to diving accidents.
Emergency preparedness courses
EFR (Emergency First Response), Rescue Diver, and DAN DEMP are the recommended courses for all active divers. Not replaceable by educational guides.