Steven P. Hughes
Katie loved photography. While on vacation in the Florida Keys with her parents, she decided she wanted to get pictures of some fish and coral to show her friends back home. As neither parent was much of a swimmer, they took Katie to the dive and snorkel shop at their resort to get her a guide. Katie was 13 years old and had never been diving before. The shop assistant suggested a surface-supplied air (SSA) dive as a good beginner option. Unlike scuba diving, the SSA system would allow Katie to breathe from a regulator and hose attached to an air source at the surface. While it was presented as an easy beginner option, SSA diving has the same risk of pulmonary barotrauma and arterial gas embolism as scuba diving. Katie’s parents didn’t understand this; they were just relieved that Katie would be connected to the surface the whole time.
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The guide gave Katie a brief orientation, outlining how to clear her ears at depth and stressing the importance of breathing continuously through the regulator. During the briefing, Katie was thinking about the wildlife she would try to photograph. The guide was about to attach Katie to the SSA system when she asked about taking pictures. He wasn’t entirely comfortable giving her a camera, as photography can be a distraction, especially for inexperienced divers. However, Katie’s parents insisted. After some convincing, the guide allowed Katie to bring a camera.
Once underwater with a camera, Katie was entranced. At 10 to 15 feet deep, the bright sunlight made the fish and coral dazzling to watch. She pointed her camera at everything she saw. Her guide had to keep waving at her to get her attention for check-ins. Partway through the dive, the guide noticed that Katie was holding her breath while taking photos. He immediately signaled for her to keep breathing. The guide had to ask her to stop holding her breath multiple times over the course of the dive. It is important to realize that divers experience pressure changes even in shallow water. In fact, the greatest changes in gas volume happen in the first 15 feet of water. If a diver holds her breath while moving up even a few feet, that can cause trauma to the lungs.
Katie wasn’t ready to use a camera underwater. It became a dangerous distraction when she didn’t want to focus on anything else but taking photos. Katie hadn’t paid attention during the briefing, and she was distracted underwater—it was an accident waiting to happen.
As they walked back to their hotel room at the end of the dive, Katie was describing the fish to her parents when she felt a sharp pain and burning sensation in her chest. The burning sensation continued into the night and disturbed her sleep. The pain slowly improved but was not fully gone by the time they returned home two days later. Her parents then took her to the doctor.
In this case, Katie was lucky. The pediatrician found that her chest X-ray was normal. There was also no sign of air trapped beneath the skin, and she displayed no neurological deficits. An explanation for Katie’s transient chest pain is mediastinal emphysema, a condition characterized by gas bubbles trapped within the mediastinum. This can occur when small parts of the lung rupture during pressure changes on a dive without appropriate exhalation. The air from those parts of the lungs likely diverted to the area around the heart, causing chest pain that eventually recedes with time as the gas bubbles are reabsorbed by the body. Katie’s case was relatively mild, but things could have been much worse. Holding your breath while breathing compressed air, especially near the surface, can cause irreversible damage like a pneumothorax or arterial gas embolism.
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Lessons for Life
1 Shallow dives are not without risk.
Holding your breath can lead to severe lung injuries. Always breathe continuously.
2 Ensure young divers are ready.
If children are unable to acquire a skill or if they repeatedly violate safe diving procedures, it might be best to put off diving and try again when they are older.
3 Pay attention to briefings, and don’t get distracted.
Incorporating new and complex tasks (like photography) into a dive can result in injury for any diver, especially a new one. A diver should be confident in their abilities before they add complexity. The first priority for every dive should be everyone’s safety.
