The Editor says: Freediving is growing more and more popular, but accidents keep happening — and blackouts (Shallow Water Blackout, or BO) are one of the leading causes of freediving fatalities. Just as with scuba diving or general beach-related accidents, we can never completely eliminate risk. What we can do is arm ourselves with the right knowledge — before and after an incident — to reduce that risk to a minimum. This article is reproduced from 簡姿馨's personal Facebook page. Drawing on a real-life BO incident, she reflects on how we can reduce risk before every dive, and what the right mindset should be when an accident does happen, so we can minimize harm.
The aim of this article is not to blame anyone involved, but to reflect on how to reduce the likelihood of accidents — and how to respond appropriately if the worst does happen.
There were two groups at the pool that session.
One was me and my dive buddy — three of us in total.
The other was the girl who had the BO, along with her dive buddy — three or four people.
The water was warm that day (around 30°C), comfortable enough without a wetsuit.
-
1
PMMy dive buddy and I had already finished our practice for the day and were casually blowing bubbles in the 5-metre zone to kill the remaining time.
I noticed that the other group wasn't wearing fins — they appeared to be holding themselves upright on the pool floor (possibly on a half-breath), without floating up.
The two groups were about 15 metres apart.
Close to 1
PMI was going for one last dive — after blowing bubbles on the pool floor, I turned around and was about to kick up to the surface.
At that moment, I saw the girl lying face-down on the pool floor, with her dive buddy beside her. Their posture looked very much like a surface static apnea (STA) practice and buddy watch — except they were on the bottom of the pool.
It struck me as odd. With her face that close to the floor, I thought, could her buddy even see her expression? But I didn't swim over.
As I was nearing the surface, I glanced in their direction one more time — and saw her dive buddy kicking hard with fins, hauling her upward.
I froze for a moment. I surfaced, looked to my right and saw both of my dive buddies already at the surface too, then looked to my left and saw her dive buddy and their instructor pulling her out of the water onto the poolside. From a distance, her body looked completely limp — not a single voluntary movement.
I ripped off my fins and sprinted over. Even at that point, I still wasn't sure whether this was a real BO or a rescue drill.
-
Then I saw the most ashen face I have ever seen in my life lying on the ground.
White tinged with purple. Lips dark purplish-black. Eyes slightly open, eyeballs protruding and shot through with red. Her body had no colour at all — completely bloodless — and the extremities and the inner joints of her limbs were also purple.
She was completely unconscious, but she still had a pulse.
The lifeguard on duty and my dive buddies rushed over when they saw what was happening. The instructor, students, and another instructor from the next session happened to arrive at the same time — one of them was a doctor.
The instructor positioned the girl in the lateral recovery position. The doctor and I took over, making sure her airway wasn't obstructed. In the recovery position, we noticed her upper limbs were extremely rigid.
Over the next minute or two: the instructor called an ambulance; the doctor asked the dive buddy to bring a towel, and asked the staff for an oxygen cylinder (though they could only produce something resembling a small portable hiking oxygen canister); one of the instructors asked the dive buddy for the girl's name; and everyone kept calling out — "Bunny (not her real name), come back! Breathe!" — but there was no response. I held the towel and cradled her head on my kneeling thigh, and for a moment the thought crossed my mind that she might not wake up.
Then her lips recovered a little colour — though her face remained pale — and her breathing was still very faint. Her eyes were open a little more than when she had first been brought out of the water, the eyeballs more protruded, and each eye had two or three red petechiae (blood spots).
Over the next three minutes, the girl began to show signs of response — not full consciousness.
First, her tongue began to involuntarily thrust outward with force. I don't know how else to describe it or why it happened, but it resembled the involuntary movements you sometimes see in adults with athetoid cerebral palsy. Then she expelled her first mouthful of water — only a small amount, fairly clear.
After that came a continuous stream of screaming. Yes — very loud and harrowing. There really is no other word for it but screaming, crying out. It sounded entirely involuntary and agonising — truly terrifying. (I'm sorry to describe it that way.) As she screamed, her body, head, and neck convulsed with great force. All I could do was try my best to brace her so she wouldn't hit her head.
We weren't sure whether this was LMC (Loss of Motor Control), a seizure, her body trying to expel water, a reaction from believing she was still underwater, or simply a response accompanying the return of consciousness.
To contact her family and get her medical history, her dive buddy brought her phone and tried to unlock it with a fingerprint — but it was Face ID, and her eyes couldn't focus at all, so it wouldn't unlock.
Eventually my strength gave out, and I handed off to another person in the group. They later described how exhausting it was — trying to protect her head while not pressing too hard and risking a neck injury.
I stepped back and, following others' directions, fanned her with a fin whenever there was a gap, hoping she could get enough fresh air. She continued to thrust her tongue out forcefully. Then came a second, then a third mouthful of water. The second was also fairly clear with a slight brownish-red tinge; I didn't see the third — someone else said it had a pinkish, foamy quality, suggesting her lungs had been injured. (The first two mouthfuls likely came from her stomach.)
After expelling the water, her breathing became more noticeably stronger. Everyone kept calling "Bunny! Breathe!" — until one of the instructors asked her, "Bunny, are you back with us?" and she answered "Yes." Only then did everyone begin to breathe a collective sigh of relief.
The doctor and instructor continued to guide her: "Bunny, listen to us, follow along — inhale, exhale, inhale, exhale…" and asked whether she could recite a family member's phone number from memory.
Then the paramedics arrived. They first put an oxygen mask connected to a portable cylinder on her, then took her blood pressure and blood oxygen readings. Her blood pressure was slightly elevated. Her blood oxygen could not be measured, because every finger and toe was painted with white-grey nail polish. The girl was finally lifted onto a stretcher and taken to hospital in a seated position.
Update: Following up with the instructor afterwards — the diver is fine and made a full recovery.
-
That evening at dinner, we talked through a few ideas that might be worth advocating going forward:
Your dive buddy would rather be embarrassed than afraid to act
Looking back at what happened, there were two moments when I sensed something was off — once when the girl was lying face-down on the pool floor, and once when I saw her being pulled to the surface — but my response was still not fast enough.
From now on, in any situation, the moment something feels even slightly wrong, act immediately, and call out to others for help.
A dive buddy is more than just an underwater companion
Even in a swimming pool, it may be worth exchanging emergency contact details and medical history with each other beforehand — it's simply a more cautious approach.
Strictly observe the dive buddy system
In every setting — a regular pool, a 5-metre pool, a freediving cube, or the open ocean. Carefully plan, communicate, discuss, and follow your dive plan.
The girl that day was fortunate — her dive buddy was strong enough to haul her up from the bottom of the 5-metre pool without fins. Going forward, even if a buddy is diving without fins, there should always be at least one person on watch who is wearing fins.
If you love the ocean, set vanity aside
Please remove nail polish before diving. Beyond protecting the ocean, certain nail polish colours prevent clip-on pulse oximeters from measuring blood oxygen saturation (SpO₂) levels accurately.
Safety equipment at the venue
It's unclear whether that particular pool facility had a portable oxygen cylinder on hand. Whether for swimming or any other sport, an oxygen cylinder seems to me an essential piece of emergency equipment. (The Editor adds: Some dive shops are equipped with an AED (Automated External Defibrillator) and a portable oxygen cylinder. The investment is significant and may never seem to "pay off" — until an accident happens. At that moment, that equipment could save a life. When booking with an instructor-led group or organising a trip independently, it may be worth asking the shop in advance whether they have these on hand, and using that as one of your criteria for choosing a shop.)
Don't crowd around — leave the space to the professionals
In a case involving hypoxia combined with near-drowning, fresh air and the expulsion of water are critical. During a rescue, please keep your distance so that air can circulate freely. Avoid clustering around the casualty. Remember the recovery position (on the side) — it prevents chest compression, stops the tongue from blocking the airway, and helps any vomit or blood from draining out.
All in all, this was a hard and forceful lesson.
Here's hoping there is never a next time — but if there is, I hope I can do better.
Thank you to my dive buddies for their help and reassurance. We will all be more careful from here on.
Will add more if anything else comes to mind. Dive safe, everyone!
Cover photo credit: Photo by Jeremy Bishop on Unsplash
Personal Facebook: 簡姿馨
