DAN ON-SITE NEUROLOGICAL EXAM
Medical Personnel will find information regarding the injured diver’s neurological status to be useful in not only deciding the initial course of treatment, but also in the effectiveness of the treatment. Examination of an injured diver’s central nervous system soon after an accident may provide valuable information to the physician responsible for the treatment. The On-Site Neurological Exam is easy to learn and can be performed by individuals who have no medical experience at all. To achieve proficiency, the exam should be practiced on normal divers under non-emergency conditions.
The exam can be practised step by step from this guideline and should be performed in the correct order. However, any test that requires the diver to raise the head above the chest should not be performed in the field on a diver who has had neurological symptoms within 30 minutes of surfacing from a dive.
• Does the diver know his name and age ?
• Does the diver know the present location ?
• Does the diver know what time, day and year it is ?
Even though a diver appears alert, the answers to these questions may reveal confusion so they should not be omitted.
Have the diver count the number of fingers you display, using two or three different numbers. Check each eye separately and then together. Have the diver identify a distant object. Ask the diver to read a few printed words with each eye.
Tell the diver to hold the head still, or you gently hold it still, while placing your other hand about 45 cm (18 inches) in front of the face. Ask the diver to follow your hand. Now move your hand up and down, then side to side. The diver’s eyes should follow your hand and should not jerk to one side and return. Check that the pupils are equal in size.
Ask the diver to purse his lips and look carefully to see that both sides of the face have the same expression. Ask the diver to grit the teeth. Feel the jaw muscles to confirm that they are contracted equally.
To be sure sensation is present and the same everywhere, instruct the diver to close the eyes while you lightly touch your fingertips across the forehead and face.
Hearing can be evaluated by holding your hand about 60 cm (2 feet) from the diver’s ear and rubbing your thumb and finger together. Check both ears, moving your hand closer until the diver hears it. Check several times and compare with your own hearing. If the surroundings are noisy, the test is difficult to evaluate.
5. Swallowing Reflex
Instruct the diver to swallow while you watch the ‘Adam’s apple’ to make sure it moves up and down.
Instruct the diver to stick out the tongue. It should come out straight in the middle of the mouth without deviating to either side.
7. Muscle Strength
Instruct the diver to shrug shoulders while you bear down on them to observe for equal muscle strength. Check the diver’s arms by bringing the elbows up level with the shoulders, hands level with the arms and touching the chest. Instruct the diver to resist while you pull the arms away, push them back, up and down. The strength should be approximately equal in both arms in each direction. Check leg strength by having the diver lay flat and raise the lower legs while you resist the movement.
8. Sensory Perception
Check both sides by touching lightly as was done on the face. Start at the top of the body and compare sides while moving downwards to cover the entire body. The diver’s eyes should be closed during this procedure and they should confirm the sensation in each area before you move to another area.
9. Balance and Coordination
When performing this test, be prepared to protect the diver from injury. First, have the diver walk heel to toe along a straight line while looking straight ahead. Have the diver walk forward and backward for about 3 meters (10 feet). Note whether the movements are smooth and if the diver can maintain balance without having to look down or hold on to something.
Next, have the diver stand up with feet together, eyes closed and hold the arms straight out in front with the palms facing up. The diver should be able to maintain balance if the platform is stable. Your arms should encircle, but not touch, the diver. Be prepared to catch the diver if they start to fall.
Check coordination by having the diver move an index finger back and forth rapidly between the diver’s nose and your finger held approximately 0.5 meter (18 inches) from the diver’s face. The diver should be able to do this even if you move your finger to different positions.
have the diver lie down and, while keeping his eyes closed, slide the heel of one foot down the shin of his other leg. The diver should be able to move his/her foot smoothly along his/her shin without jagged side-to-side movements.
Special Considerations for On-Site Neuro Exam
• Check these tests on both right and left sides and observe carefully for clumsiness on either side
• The diver’s condition may prevent the performance of one or more of the tests. Record any omitted test and the reason. If any of the test results are not normal, injury to the central nervous system should be suspected. Report the results to the emergency medical personnel responding to the call.
• The tests should be repeated at 30 to 60 minute intervals while awaiting assistance in order to determine if any change occurs.
• Good diving safety habits include practicing this examination on normal divers to become proficient in the test.
• Examination of an injured diver’s central nervous system soon after an accident may provide valuable information to the physician responsible for the treatment.