IPO refresher Immersion Pulmonary Oedema is the water hazard we should all understand. Sophie Rennie and Sophie Heptonstall set out the essentials
TWOSOPHIES
IPO refresher Immersion Pulmonary Oedema is the water hazard we should all understand. Sophie Rennie and Sophie Heptonstall set out the essentials
THE QUESTION:
“ Having experienced an IPO myself, I’ m not sure all divers are aware of the symptoms and treatment. Could the Two Sophies provide a refresher on IPO?” Chris O’ Donohoe
People experiencing IPO sometimes believe their regulator isn ' t working
Sophie Heptonstall sets out the essentials
Immersion Pulmonary Oedema( IPO) doesn’ t care how experienced you are, how fit you are, or whether you’ re wearing a cylinder, a snorkel or just a swimsuit. It’ s a condition triggered simply by being immersed in water – and awareness could save a life, whether yours, your buddy’ s, or a swimmer’ s at your local open water site.
What is IPO? When we enter the water, hydrostatic pressure squeezes the veins in our limbs, pushing extra blood towards the heart and lungs. Cold water and exertion amplify this effect. In some people, the increased pressure causes fluid to leak from the blood into the lungs – making it progressively harder to breathe. Once thought rare, IPO is now recognised as a significant factor in diving incidents, and BSAC has highlighted it in the Annual Diving Incident Report since 2016.
Reducing your risk: Some simple precautions can help:
■ Know your blood pressure. Hypertension is a key risk factor – if yours is high, speak to a UK Diving Medical Committee medical referee before diving.
■ Don’ t over-hydrate. Stay sensibly hydrated, but avoid drinking excessive fluids before entering the water.
■ Avoid extreme exertion. Plan dives and swims to minimise hard finning against currents. Even very fit individuals can be affected.
Recognising the signs: IPO can look confusingly like an equipment problem. Watch for:
■ Breathlessness, heavy or uneven breathing, or persistent coughing – sometimes with frothy or blood-stained sputum
■ A diver convinced their regulator has failed or they’ re out of gas, when checks show otherwise – or refusing an alternative supply
■ Confusion, swimming in random directions, or struggling to do anything except concentrate on breathing
■ A swimmer or snorkeller in visible respiratory distress at the surface
What to do: Get out of the water – fast but safely. If it’ s you, end the dive or swim immediately; if it’ s someone else, assist them from the water as quickly as it is safe to do so. Then:
■ Sit the casualty upright if conscious – this is different to DCI but lying flat can cause more breathing restriction
■ Give oxygen if available and keep them warm
■ Loosen or remove tight suits and clothing
■ Do not give fluids
■ Call 999 – IPO is a medical emergency
Anyone who has experienced suspected IPO must stay out of the water – no diving, snorkelling or swimming – until assessed by a diving doctor, as recurrence risk is significantly higher.
Encourage club members to visit the BSAC website for guidance, watch the presentation or hold your own presentation on IPO to increase awareness in your club or centre.
Further guidance can be found at bsac. com / safety
Sophie Rennie summarises
Not many people are aware of exactly what Immersion Pulmonary Oedema( IPO from now), is, and what exactly happens to the body if you are affected.
It is a life-threatening condition where the alveoli in the lungs fill with fluid. It could equally be described as drowning from the inside-out. Anyone who spends time in the water, including swimmers, snorkellers and divers, can be affected. It is due to hydrostatic pressure and cold water pushing blood centrally, and this, in turn puts a much greater pressure on the heart, forcing fluid to leak into the airways. Factors which might support an IPO: Cold water immersion; hyper-hydration; overexertion; high blood pressure and high breathing resistance( especially when you inhale). Symptoms: Coughing, shortness of breath, coughing up bloody sputum, difficulty breathing and extreme fatigue. Actions: Get out of the water, stop all exertion, rest in a seated position and get on Oxygen. Always seek further medical help – go to hospital. �
Do you have a question about dive training, kit or safety for the Two Sophies to answer? Email SCUBA Editor Simon Rogerson, simon @ scubamagazine. co. uk
23