TTMWL: Episode 18 — “Diving Dangerously: The Importance of Dive Emergency Care” with Dive First Responder’s Dr. Richard A. Clinchy III & Dr. Timothy A. Coakley

Training the Modern Workforce Live is a show discussing training and talent development solutions and best practices. Hosted by Allogy CEO Colin Forward, each episode features an informative conversation with a prominent guest in the training world.

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About Dr. Richard A. Clinchy & Dr. Timothy A. Coakley, Authors and Developers of Dive First Responder

Dr. Richard A. Clinchy III started SCUBA 65 years ago and has international teaching experience on all continents. He’s been a paramedic since 1980 and is the developer and author of Dive First Responder, with a second edition currently in development with Dr. Coakley.

Dr. Coakley has been in clinical practice of emergency and hyperbaric medicine for over 25 years. He is a retired commander in the U.S. Navy after a 30-year career in special operations and deep sea diving with combat tours. He just accepted a position as the chief medical officer for a commercial dive school as well as a biophysics professor at CalPoly Humboldt in Eureka, California.

Adam Wagner: Hello, everyone, and welcome back to Allogy’s podcast, Training the Modern Workforce Live, a show discussing training and talent development solutions and best practices. Each episode, we’ll talk about a different training topic, and make sure to keep an eye out for special guests and interviews from top training professionals. 

With me, as always, I have Colin Forward, CEO of Allogy. For the last decade, Colin has provided major U.S. hospitals and federal agencies with distance learning solutions. He studied mobile technology at the University of Central Florida while earning a degree in computer science and his MBA. 

And joining Colin this week are Drs. Richard A. Clinchy III and Dr. Timothy A. Coakley. Doc started SCUBA 65 years ago and has international teaching experience on all continents. He’s been a paramedic since 1980 and is the developer and author of Dive First Responder, with a second edition currently in development with Dr. Coakley. 

Dr. Coakley has been in the clinical practice of emergency and hyperbaric medicine for over 25 years. He is a retired commander in the U.S. Navy after a 30-year career in special operations and deep sea diving with combat tours. He just accepted a position as the chief medical officer for a commercial dive school as well as a biophysics professor at CalPoly Humboldt in Eureka, California. 

Today we’re gonna be talking about the importance of dive emergency care. We’ve got some great questions on deck already, but feel free to ask any questions that may come up in the chat, and we’ll get to as many as we can. 

Alright, Colin, over to you. 

Colin Forward: Alright, thanks, Adam. Doc and Tim, thank you both for being here today. We have a lot of great people on this podcast that have varying expertise, and it’s always good to talk to people that can help us better understand their domains, but it’s unusual that we have people who are truly pioneers in their field the way that Doc is and doing such interesting and pioneering work even today as Adam alluded to in Tim’s introduction.

So I wanna take a minute to let you both introduce yourselves and share a little bit about your background. And I know we can’t cover all of the things that you guys have done in the time that we have, but I’m interested to let the audience know how you all got to the point that you’re at today. So, Doc, why don’t we start with you?

Dr. Richard A. Clinchy: Okay. Well, I started diving when I was 16 years old, so that was 63 years ago. Back in those days, there was no certification program. You just bought equipment and taught yourself how to dive. My late best friend Bill Lockridge and I used his father’s boat, and we taught ourselves how to scuba dive in Long Island Sound.

Fast-forward to the mid-80s when I was a territorial paramedic training officer in the U.S. Virgin Islands, and it became very evident that the average diver and dive boat operator knew very little about how to handle medical emergencies in the diving setting. Also, at that time, we were setting up the recompression chamber in the U.S. Virgin Islands with Dr. Rick Leisse, and we were then the recipient of the majority of diving accidents that occurred down through the Greater and Lesser Antilles.

So it became even more evident that folks did not know how to handle medical emergencies or diving medical problems, and that then prompted me to develop the Dive First Responder course and ultimately the book. Over to you, Tim. 

Dr. Timothy A. Coakley: Thank you very much. It’s a pleasure to be here. As Adam mentioned, I’m a clinical emergency medicine physician. I’ve done that for over 26 years as well as a 30-year military career. I was an enlisted medic. Learned all about combat medicine at that time.

I started getting interested in diving when I was enlisted. And then, of course, I wanted to be a deep-sea diver and a special operations physician for the seal teams, the EOD, the combat salvage divers, and the Seabees. So I took that course—very rugged course to complete—and that led into air operations and all kinds of things. A really really fun career for me.

But diving and hyperbarics have always been very close to what I wanted to do with the rest of my career. After doing that and still working clinically, this is what I really like doing. I love diving and deep sea operations. 

Colin Forward: Great. Thank you both. So, I’m not a diver myself. I’m kind of learning a lot about this through our conversations, and I think some of our listeners might be in the same boat—and maybe some of them have been dive certified, and so they know that there are plenty of places out there that you can learn how to dive, you can learn the safety precautions that people should take to prevent needing the kind of help that you provide. But it sounds like there’s not really the same level of training and availability of that training when it comes to what to do when someone does get hurt diving. So is that accurate? Can you describe the situation when it comes to emergency response training in diving? 

Dr. Richard A. Clinchy: Tim, do you wanna start? 

Dr. Timothy A. Coakley: Sure. It’s not, unfortunately. I’ve done this for so long. I’ve had some fantastic deep-sea dives that I can talk about for hours. But being with the U.S. Navy, all over the world—and even here, domestically—that the first responder stuff—

Actually, Doc had the first book, and to my knowledge, the only real book on how to handle diving medicine emergencies out in the water. But just the basic things—as I teach for combat medicine with first aid kits—that are taught here will save lives. You can’t just make a phone call and hope they get taken care of. There are things you can do there. So I know for a fact it’s not being universally taught to the level of just even basic introduction. And this is basic first aid for diving casualties. 

Dr. Richard A. Clinchy: Yeah. And I would add, I think it was my exposure that prompted me to write the book and develop the course. I was getting on dive boats and realizing that they didn’t have the right equipment on board in the event something went wrong. Very simple stuff like a portable oxygen system, airway management devices, etcetera. They just weren’t there, and if it had been there, they probably wouldn’t have known how to use it anyway. So it’s been an interesting journey, to say the least. 

Colin Forward: So before we get too far, we do have a lot of folks in our audience that are first responders and even a lot of folks that practice medicine in some pretty extreme conditions like in combat settings. There are very few settings that are more extreme than deep-sea environments. I know that’s used sometimes as a proxy for training in space, even. Just in case it’s of interest to the audience, what’s the name of the book that you were referring to?

Dr. Richard A. Clinchy: The book is called Dive First Responder. It was written in 1996 or published in ’96 by Mosby Lifeline, and Tim and I are working on the second edition right now and are in conversations with two different publishers to bring it out. We’re gonna make it smaller, and we’re gonna have it printed on waterproof stock so it can be tossed on a dive boat and still be usable.

Colin Forward: Awesome. Yeah, so our audience can Google that if that’s something they’re interested in, maybe understand how some of the skills you’ve learned get pushed to the next level when you’re in this kind of environment. There are a lot of standards in all these different areas of emergency response, right? We have groups that maintain a certain quality expectation for the training that you need to become a first responder in any given field. What’s the state of standards in dive first response?

Why Is Dive First Responder So Important?

Dr. Richard A. Clinchy: Tim, you wanna try that one? 

Dr. Timothy A. Coakley: I’ll definitely say I’ve not, in my multiple-decades career, seen any at all. It’s usually rolled up into a regular standardized diving certification, but there’s no breakout. There’s no true understanding of dive first responder.

Again, this is first responder. That means first aid—basic stuff. It’s not like you’re going for paramedicine or even an EMT tech. This is just stuff that I think everybody that gets on a dive boat needs to have at their fingertips, at least, or some familiarity with it before they get out there. And it could save their life, and it could save the lives of their fellow divers out there.

Dr. Richard A. Clinchy: Yeah, and I would say that when I wrote the book and developed the course, I tailored it around what was then called “first responder,” now it’s called “emergency medical responder.” But it was tailored for the diving environment. So we threw in a lot of fundamental first responder information in terms of what you needed to know in an emergency, but then also threw in the information in terms of what you need to know in the diving setting in the event something goes wrong.

I think the classic thing that we chatted about the other day, when we were running the chamber in St. Thomas and people were gonna fly patients up from wherever down east, we would have to caution the pilots to fly at wave-top level bringing the patient up. They didn’t understand that if you take a dive accident patient up to altitude, you’re probably gonna exacerbate their condition and perhaps kill them, particularly if it’s an air-gas embolism. So it’s a lot of basic stuff that comes into play when you’re dealing with somebody that’s been submerged.

Colin Forward: So that kind of begs the question. If you’re on a boat and you’re diving, then it’d be great to have someone who’s read this book or received the kind of training that you all offer. But if someone gets hurt in a dive environment, then what happens? You mentioned this airlift situation; but what’s the protocol?

Dr. Richard A. Clinchy: You wanna try that, Tim, or do you want me to jump on it? 

Dr. Timothy A. Coakley: Sure. The basic information that’s out there for dive masters or people that are actually supervising diving, or should be supervising diving, is what they call the Divers Alert Network. And that’s a worldwide network of hyperbaric physicians like myself. And then, they can put you in contact with the local resources, which is very critical. And I highly recommend them. I’ve been around it a long time.

The thing that we’re looking for is basic stuff that you can do while you’re contacting them that will save lives and lessen bad outcomes. But yeah, I definitely recommend them. That’s probably the first thing that’s in every dive course. If you got a problem, you call DAN, Divers Alert Network, and they’ll put you in contact with resources. 

Colin Forward: So anyone can call DAN, but what we’re talking about today is really the sort of things that you can do between when an accident happens and when you can actually get to a facility or when you can get that help that might save someone’s life.

Dr. Richard A. Clinchy: Well, I think some real simple basics would be keeping them laying down and if you’ve got oxygen, give them oxygen. But as Tim said, Divers Alert Network is a great resource. They will basically coach people through what to do. Typically, they will end up getting the patient referred to a recompression chamber somewhere—the nearest one—and they know where the chambers are that are active.

Dr. Timothy A. Coakley: And that’s the big thing is getting to a chamber as soon as possible for evaluation. The other thing is dangerous marine envenomations. There are all kinds of things out there that can sting and bite and paralyze. So having a basic familiarity with that, even at a contact or photographic level is important.

Then, there’s the treatment. And Doc and I are working on an addition or project to try to delineate that better with publication. But that’s the beauty of having information like that. You can say, “Oh man, I had this bite me. What is it?” I could go on and on about that. 

Colin Forward: I thought it was interesting Doc mentioned that the new version of the book is going to be waterproof—and that makes sense, given the environment—but it makes me wonder: what are some of the challenges with reaching the audience that would be interested in this book? Because, as you mentioned, this is a worldwide industry, or worldwide discipline, where there’s not necessarily, to my understanding, a lot of centralization in how this information is distributed. We mentioned that there are not a lot of standards. So what kind of challenges are you facing when it comes to getting this information into the right hands? 

Dr. Richard A. Clinchy: I think part of what we’re doing with you all, in terms of making an online course available for people, reasonably priced—they can at least get the basics from that course. And then, the book can be added as a supplement. And if folks wanna teach the Dive First Responder course in its entirety, face to face with folks, we’ll be glad to get them set up to do so. 

Colin Forward: So just some context for anyone listening in: Allogy is working with Doc and Tim to put together a course on our Capillary platform that would be available worldwide. I’m curious, so beyond just using distance learning technology like what we provide, is there any sort of organizing that’s going on behind the scenes to try and put together a meeting point, a place where you can gather all the expertise, a place where you can get the interested parties together to kinda rally around the information that you’re putting out there—especially given that there aren’t any standards?

What Are the Authoritative Sources for Dive Emergency Care?

Dr. Richard A. Clinchy: So there are two organizations, one of which Tim already mentioned, which is Divers Alert Network. The other one is the Undersea & Hyperbaric Medical Society. And most of us that have a background and an interest in diving medicine are members of UHMS, the Undersea & Hyperbaric Medical Society. Tim, you want to add in on what UHMS does? 

Dr. Timothy A. Coakley: UHMS reviews all the literature that’s out there, as it pertains to hyperbaric medicine, but also the updates in diving medicine itself. It’s a global industry. So you have commercial diving, you have sport diving, you have military diving. So it’s nice to have one central repository for the information and the absolute research leaders in this field. I really liked our organization a lot—been affiliated with them in the past and even more so now. But that, and then there are other nationally recognized dive training platforms, like the NAUI, which is the National Association of Underwater Instructors. Then, there’s PADI, professional divers, and all that.

So what we’re trying to do is collaborate with the UHMS and with the other civilian certifications so we can get this information out there, which I personally have seen not be available or being taught properly anyways in the last 20 years. And I think it has to do with the explosion of sport diving around the globe and the reliance strictly on Divers Alert Network or corporate knowledge of the dive masters that are out there. So I think these organizations are gonna be a central fund for making this happen. Of course, Doc and I are committed to putting a lot of this together because it’s been our mission for years to try to get this out.

Colin Forward: And do you see any hesitation from the folks that might be your intended audience to adopt this kind of skillset? Obviously, the legal environments are different everywhere that this might be taught, and I’m sure there are some kind of strange legal situations when it comes to being out in dive environments that may be pretty far offshore. But what is the appetite for medical skills in addition to everything that someone needs to know to be a dive instructor?

What Are the Challenges of Adoption for Dive Emergency Care?

Dr. Timothy A. Coakley: My personal experience with the diving community at large, all of them, is that they’re hungry for this information. There might be some hesitation when they say, “Do I have to have a certification in my state and local area?” Again, this is first-responder stuff. It’d be like a first aid course—any good one that’s online. We’re strictly teaching the basics. We’re not talking about medical or surgical interventions, per se, just oxygen and other things that couldn’t make things worse. There are simple treatments out there.

But as a group, divers are traditionally risk takers or adventure seekers or gregarious in their behavior. So they’re always hungry for information, especially when they realize they’re way out there in austere environments, and they wanna have something that they can grasp other than a phone number. 

And getting back to that, the communications can be very lagging depending on where you are, of course, depending on how far out or what you’re doing or all those different facets. So having the publication and having the ability to reach out—whether it’s the app, which we’re developing right now, which I think is a great resource and repository—or whatever. I do find that there’s a hunger for this information out there. It’s just that when you start asking about it, “Well, how much dive training for medical response or emergencies have you had?” They all just clam up and go, “What do you mean? I guess we’ll lay them flat and let the dive master take care of that.” 

So I really want to bring this to the forefront because we’re seeing a lot of casualties—especially in the commercial diving industry—and that has to do with so many factors I won’t go into. But having the right medical skillset there, and also in sport diving, I know we can make an impact on saving lives and lessening bad outcomes.

Dr. Richard A. Clinchy: I’ll share an anecdote to put some of it into perspective for you, Colin. When we were running the chamber in St. Thomas, as soon as we had the chamber open, the Navy folks over at Rosie Road said, “Fine. You’ve got all the civilian diving accidents from now on.”

So on a regular basis, COT divers in Puerto Rico would dive all week long. They didn’t pay much attention to tables. They would get enough rum into them during the week so that they could function the next day. And then, by Friday, they’d be in such bad shape that we’d get a phone call, and they’d fly these guys over from Puerto Rico, and we treat them in the chamber. That is not atypical of what you see around the world, unfortunately. 

Dr. Timothy A. Coakley: In Guam, for instance, one of the busiest dive chambers in the world, frankly speaking, we get divers from all over the south Pacific that come up there, and we treat them. But the thing that’s lacking is training like we talked to but also the fact that a lot of divers don’t understand a lot of the dive physics when they get in the water. So I’m all about prevention—it’s what I’ve dedicated my career to—and then treatment. So that makes a lot of sense.

Colin Forward: So yeah, you’ve really illustrated how broad, geographically speaking, this problem is and the need is. You mentioned a couple of the organizations that are getting stood up to support the demand for this kind of training. What does it look like to empower people to deliver that training locally, beyond a book an app?

We have a lot of training professionals that listen to this podcast, and they might be curious about how information flows from experts like yourselves down to these end-users who are ultimately the point of care. So are you standing up franchises? Is there a train-the-trainer model? What do you think it’s gonna look like to empower people to deliver the care that you’re teaching?

How Do You Empower Local Trainers to Teach Dive Emergency Care?

Dr. Richard A. Clinchy: When I developed Dive First Responder, we stood up an organization called the International Association of Dive First Responders. And it’s from that organization that we will be issuing the certificates from the course that Tim and I are doing with you all. We’re certainly prepared to expand the reach of the International Association of Dive First Responders to develop train-the-trainer programs and try and get instructors around the world to teach Dive First Responder. 

So the short answer is yes, we’d love to expand the reach because it’s going to help divers stay healthy. And I think what we mentioned earlier, Divers Alert Network, is a first-line resource that anybody that gets hurt in a diving environment needs to reach out to because they will provide great guidance and tell you where you need to go. But we’d love to expand the Dive First Responder concept to make it international in order to have folks trained in terms of what to do when you’re on the scene. 

Colin Forward: If we might have someone who’s interested in being a part of this effort that happens to come across the podcast, what type of people should reach out to you if they’re interested in being a part of this effort?

Dr. Richard A. Clinchy: My goodness. I would say anybody that’s interested in diving and interested in diving medicine. You don’t have to be a doc. You don’t have to be a paramedic. It is, as Tim mentioned, a first responder-level course. And I think if we could get just get scads of people out there taught up to that level, we certainly would improve the safety factor in diving.

Dr. Timothy A. Coakley: Yeah, I agree with that. I think Colin had a really good point, and it was how do you get it out there? I’m looking to get it to the PADI, the NAUI, and the SSI. Those are all separate organizations that do certifications. I’d like to get it in their shop. So traditionally, I see people that are teaching diving that say, “Hey, I hadn’t heard about it.” Or they hadn’t heard about it at all. Or the most important was, “Hey, I wanna learn how I can teach better for my students.” 

So that’s why we’re offering certification through the app we’re all developing. But just having that kind of a model and having it explained as opposed to saying, “Oh yeah, there’s this resource. Just go look it up.” I think that train the trainers is the most important thing because where they’re getting all their diving information, it’s coming from fantastic courses. And they do, they touch the surface of it, but I’d like to have just a little bit more expansion and say, “Hey, this is what we do. It’s pretty easy to teach.” And that way, everybody will have that contact familiarity. 

Coming from a combat medicine background with Marines and Special Forces and the Army, I always wanted to make sure I had help if anything happened to me—because I’m selfish; I wanted to go home—so I trained them to know exactly what to do for the immediate upfront situation where you can save the most lives. So train the trainer is one of the big things that I’d like to do to get out there and teach them so they can teach others. 

Colin Forward: So I’m curious if the attitude that you described that I’ve seen in lots of combat medics—where they are just so eager, and they want to be prepared because it’s their buddy’s life that they might be saving—is that the same attitude that dive masters and dive instructors have, or is the responsibility put off on the Divers Aware Network and the medical providers that might be in their orbit? 

Dr. Timothy A. Coakley: I think we’re half and half, actually. I think that it’s either not knowing in-depth information or no ability to teach it. And then, I think it’s the other thing where they do wanna teach it, and they’re out there trying to figure out where they can find the information in a standardized teaching model.

So I think it’s a little bit of everything you said, Colin, but I think that if there is a standard, any standard, any certification standard to a basic level, I think that helps because then they can always reach out and touch that and say, “Yes, these students have reviewed these basics, and they can do these basics.” I think that makes the biggest difference when you put in muscle memory as well as teaching.

Dr. Richard A. Clinchy: Yeah, the thing I’ll also add: Tim mentioned three different dive agencies. I was a dive master with one of them, an instructor with two of them, and an instructor-trainer with one of them. And the one thing that I see, and I don’t mean to be nasty about it, but there is, in the diving community among the dive certification agencies, a not-invented-here mentality. In other words, if we come through the door to them and say, “Here, we’ve got a course put together. Offer it to your people,” there will be some resistance to that because they didn’t create it. And I’d love to see that go away because we are willing to just throw this thing out there and let folks have it. And our only interest is to see it get taught. 

Colin Forward: Yeah. And that kind of adoption is a challenge that we see in almost every training environment, whether it’s corporate training and going through change management or the fact that it sometimes takes, I think, on average it takes 10 years for a best practice to get to clinical practice guidelines. So that’s a lot of outcomes that could be improved, a lot of lives that could be saved in the course of that. 

Dr. Richard A. Clinchy: It’s a lot of casualties. 

Colin Forward: Right, exactly. What is your timeline when we’re talking about setting up these organizations that are hopefully going to provide a standard that people can reference?⁠ You said that someone can reach out and touch that organization and say, “Hey, this is the help we might need.” How long do you think it’s gonna take to go from where we are now? You’ve had this book out for 20-plus years, and you’ve been in the industry for even longer, but now you’re in the process of setting up these organizations. How long do you think it’ll take before we can see adoption filter down to those end users? 

How Can We Scale the Delivery of Dive Emergency Care?

Dr. Richard A. Clinchy: I’m not sure of the exact timing, Colin, but Tim and I are in the process of tweaking some of the content from the book that was written in ’96 because there have been some clinical changes that we need to incorporate and treatment changes. But we’ve got the course put together. We’ve got the book coming out in a second edition sometime before too long. And I’d be happy to turn the whole thing over to any diving agency that wanted to adopt it because it’s going to get the information out there. And they’re the ones that have got the reach now. We don’t. The three dive agencies that Tim mentioned are the folks that have the reach with the recreational scuba diving world. 

Colin Forward: So it sounds like you all are very interested in partnering to success. It’s a valuable body of knowledge that you’re looking to share with people that are pretty eager to do it. Just quickly, is there a good way that anyone who’s interested can reach out to you and say, “Hey, we might be able to help get this information into the right hands?” 

Dr. Richard A. Clinchy: I think the simple answer to that is we’ve partnered with you to do what I will call the appetizer, and certainly, they can reach out to allogy.com, and you guys know where to find Tim and me. And yeah, we’d love to partner with any of those agencies that Tim mentioned.

Colin Forward: There you go. So there’s a public call out to anyone who does dive training or plays a role in potentially getting this information to the right hands. Hopefully, anyone listening that matches that description will reach out to us, and we can make sure to put you in touch with these leading experts in the field.

Is there anything else that you think is really important for our listeners to keep in mind when it comes to why this information is so essential and some of the challenges that you might have run into in getting in out there? What should people keep in mind when they’re considering whether or not this is an investment they might want to make in their time or their resources or as an organization? 

Dr. Timothy A. Coakley: I can say from an emergency medicine clinical background that⁠—again, I’m harping on prevention⁠—if you have the knowledge, the knowledge is the power.

The chance that you can have an emergency—a true emergency or at least an injury that needs to be treated—is very high in diving—higher than what they are in the regular activities in daily living. And I say that knowing that there are certain insurance companies that increase premiums if you say you’re a sport diver.

My point is this: the chance for something to happen is there, and it’s higher than average. And if that’s the case, you definitely wanna have the baseline knowledge so you can treat yourself or treat any of the other people that are diving with you.

Colin Forward: I really appreciate you all taking the time to have this conversation with me today, and it’s a privilege to be able to work with you. I hope that we are able to get all this information that you’ve spent decades accumulating into the right hands so that we can facilitate some better outcomes, potentially save lives, and make it so that you all don’t have to be there on the front lines when someone gets hurt, and we can still get to those same outcomes.

Dr. Richard A. Clinchy: I’m 79. I’m getting a little too old to be there on the front line, buddy. 

Colin Forward: You’re creating some real public goods by capturing the information that’s stored up in that head of yours. So, thanks again for being with us today, and Adam, I’ll hand it over to you to take us out.

Dr. Richard A. Clinchy: My pleasure. 

Adam Wagner: Yeah, thanks, everyone. This was Training the Modern Workforce Live, presented by Allogy. If you’d like to explore previous episodes, subscribe to our YouTube channel or like us on LinkedIn and Facebook. And if you’d like to connect with one of our learning specialists to see how Allogy could help improve your training, head to allogy.com and schedule a demo.

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