Showing posts with label First Aid. Show all posts
Showing posts with label First Aid. Show all posts

Tuesday 8 January 2019

How to Adapt to Swimming in Cold Water

Introduction


Winter can be a wonderful, enchanting time of endless gluttony that then magically 'disappears' underneath baggy jumpers. A countryside waddle and a gaviscon may be enough to cure that hedonism-induced indigestion you've been feeling, but what can you do about that cabin fever?

    There's a reason why Winter is often nicknamed 'Cuffing Season' by the aquatically inclined, and it's obviously because you are stuck indoors and kept chained from your usual watery adventures. Here's some good news fellow amphibians - it is very possible to adapt your body for outdoor swimming during the winter months! Aside from the advantage of escaping the 'terror firma' all year round, there are many benefits to adapting to cold water swimming which I will discuss below.

Apart from instantly curing hangovers and looking like a wally for the amusement of your friends.

  But wait! Before you decide to dive bomb into your nearest icy lagoon, you'll need to prepare yourself both physically and mentally for risks such as cold water shock and hypothermia. Plus, be kind to your relatives - they'll need more than just a gaviscon after seeing you dive into your local lake instead of feeding the ducks.

'I'm swimming over to feed those moorhens, Grandma. It's my New Year's Resolution to be more giving...'

Chill out and read this first before really chilling out.
  

1. Accept that it may take you some time to acclimatise


    Just because you have impulsively agreed to swim outdoors in January doesn't mean you should be equally as impulsive when diving into cold water. Check with your doctor first to make sure it's safe enough for you to swim in Winter's bracing blue spaces, especially if your cardio health is not at its best. Be aware that cold water shock is a very real danger when swimming in water below 15°C (59°F for  Americans, 288.15 Kelvins for eccentric scientists).


The water temperature of London's Royal Docklands in January may feel like absolute zero, even though it's more like 280.55 Kelvins. It's all relative.

  Cold water shock results in involuntary inhalation so if you're underwater at the time, then you can imagine this not being a healthy situation for you. If you're not prepared, fatalities can occur in a matter of minutes. Cold water shock will also result in an increased heart rate and blood pressure coupled with vasoconstriction, which can lead to a heart attack in people with an existing heart condition. Even if you have fantastic cardiovascular fitness but you're not conditioned for cold water shock, the risk of death is still incredibly high.

It all got a bit heavy there, so here's a cute seal pup. Interestingly, seals themselves are heavy due to blubber - an adaptation for cold water swimming. See, this pic was relevant after all.
(Image from Pixabay.com)

    Fortunately you can adapt yourself to swimming in cold water if you allow yourself enough time to do prepare. A cold-conditioned person will experience a reduction in cold-shock effects and the adaptations can last for a year!

2. Build your Swimming and Cardio Fitness


    Hopefully you already like being in water and can swim. As they say, it's better to learn how to swim before you learn how to dive - and it's better to do both before you swim in cold water. Concentrate on swimming and building your cardiovascular fitness in indoor pools at standard competition temperatures of 28°C (82°F for those that like to pretend the water is warmer/301.15K for machines). Swimming pool temperatures should be no higher than 29°C, however, otherwise bacteria and algae can grow in them.


That algae didn't stop British diver Tom Daley from keeping calm and carrying on though! Look how relaxed he seems! 
(Photo from Matt Dunham/Associated Press)

    Once you're feeling confident in the water, try outdoor pools like lidos and wild swimming spaces during summertime. As there's little difference between summer and winter in the UK, you're well on your way to being sufficiently cold adapted!

  Additionally, since cold water swimming is harsh on the circulatory system, maintaining regular cardio activities other than swimming is also advised. You never know, you may well be inspired to become a triathlete and add running and cycling into your fitness plan.

'It's amazing what you can do with three legs!' - Famous Triathlete
NB: Quote may not have happened.

    If you don't have the inclination for that sort of torture, there are subtle ways you can incorporate cardio into your everyday life. Simple exercises could include forgetting why you walked into a room and then walking out (10 reps per day), or trekking a mile because you missed your bus stop (or even worse, calling for your stop much too early and accepting the consequences). Step up the cardio intensity by sprinting frantically for every public transport utility you were supposed to be on time for. Be creative! The world can be your gym! 

3. Cold Water Immersion Preparation


    If you're still reading at this point, I'm impressed. It's about to get better, trust me. Prior to your outdoor winter swim, it's advisable that you get your body used to cold water. If you've not swam  outside since summer or autumn, you can jolt your body back into conditioning via repeated cold water immersions in the (dis)-comfort of your own home. Start with a three minute cold water shower per day, for two weeks prior to your cold water swim. Splashing your face before subjecting yourself fully to the cold shower can help to reduce the effect of cold water shock.

Welcome to my world, punk.
(Image from Pixabay.com)

    Step up the shower to six minutes, then nine - see if you can go all the way up to 10-15 minutes. It's fine if you need a minute of warming-up intervals, and it's recommended that you do some warm-up exercises (e.g. 50 star-jumps) before showering. However, I suggest quickly warming up once your energising ordeals are fully over. As you get closer to the swim (and if you have access to a bath) transition from cold water showers to full-body immersion in cold water baths.

Some say that rubber ducks are optional. I confirm that they're mandatory for effective cold water adaption training.
(Image from Pixabay.com)

4. Monitor Yourself (Hypothermia Awareness)


  Whilst you do your home acclimatisation training, monitor your body's reactions to the cold and take note of how long you can cope with the cold water. If you're not seeing an improvement in your ability to adapt and all you feel is significant discomfort, stop or reduce the training. Normal body temperature is around 37°C, but if it drops to between 32-35°C, symptoms of mild hypothermia can occur. These include shivering, pale and cold skin, hyperventilation, slurred speech and confusion. If your body temperature drops below 32°C, passing out becomes a risk. It's a good idea to let someone know about your cold water adaptation training so they can help you if you need.   
  
I know I've used this photo before, but it's such a great way of showing how to treat someone suffering from hypothermia. Also, if you have a problem with this picture, there's a chance you may have hypothermia of the soul. I'm sorry you had to find out this way.
(Image from Pixabay.com

   If you suspect that you have hypothermia, warm yourself up as soon as possible. Dry yourself, remove any wet clothing, get indoors and hide inside a big coat or under lots of fluffy blankets. A warm and sugary drink may help. If you're looking after someone else that you think has hypothermia, make sure they're conscious and breathing before giving them food or drink. Hot chocolate may solve a lot of life's problems but every good thing has its limits. Remember, don't give a hypothermic person alcohol, and don't place the casualty in a hot bath or under a heating lamp. FYI, the official statement from the Outdoor Swimming Society on foil blankets is that they do not help swimmers.   

5. Dress-Code: Neoprene

 
     Cold water swimming is one of the very few activities in which being slightly overweight can be an advantage. However, even if you're feeling blubbery like that seal earlier, it's still a good idea to add additional padding in the form of a 3-5mm wetsuit combined with a 3mm neoprene vest. My cold swim wardrobe consisted of those items plus 3mm hood (silicone swimming cap underneath), polyester shorts, 4mm neoprene socks (plus inner compression socks), 2mm neoprene gloves and waterproof diving watch. If you swim with fins, make sure they still fit you after you put on those thick wetsuit socks.

A black, unisex neoprene wetsuit can be very figure flattering at this time of the year

    Since you're probably thinking of what else to pack apart from the warmest clothes you've ever owned, I strongly suggest investing in a dry robe for changing into and out of your swimming gear. Don't forget your hat, scarf and gloves, thermal vest and thermal socks.

6. Pre-Swim Warm-Up


    Once you're dressed in all your cold water swim apparel, you'll certainly start to feel toasty after 50 star-jumps and some stretches. Any exercise will help you to boost your circulation and reduce the effects of cold water shock. Plus, it will improve morale - people look hilarious when doing star-jumps anyway, let alone in wet-suits (although wearing fins at the same time may be taking this a bit too far).
    Yoga exercises will help you to calm any anxiety you may have about following through with this cold water swimming nonsense, and can help you to avoid muscle cramps.

If you combine yoga poses with a pic of yourself near water, you will have officially 'won' instagram for a second or two. #Yoga #Wellness #Blessed
(Image from Pixabay.com)

 7. Make Friends


    Cold water swimming is best done with good company, and I found that when doing the New Year's Day London Royal Docklands Open Water Swim with NOWCA, I was swimming with the best company. Everyone was incredibly friendly (united by our collective sense of dread that we were putting ourselves through), and there was certainly an atmosphere of people helping each other out if needed. The motto 'people who swear together, stick together' was incredibly relevant that day. Plus, the presence of Rick (the owner of the swimming space) was very reassuring, and this helped with another important aspect of cold water swimming adaptation - to stay calm.

Meet Rick. He's an expert at checking his watch, posing uncomfortably for photos and generally being a hero.

    To swim at a NOWCA swim site you'll need to get one of their RFID wristbands - a tracking system and a way of keeping you safe whilst swimming. It also helps you to track your progress (if any) throughout the year. 

8. Enter the Water Slowly


    Some people may jump into cold water and be OK. However, if this is your first cold water swim - do not jump in. I repeat - do not jump in. It's best to take it slow. Enter the water with your feet first, acclimatise your legs, splash your face and then slowly lower yourself into the water. Lots of loud profanities help. Keep moving once your're in, and definitely keep cursing. It's better to start swearing swimming straight away. I found that alternating between back-stroke and front crawl to be the best at keeping me warm-ish, with back-stroke better for keeping the cold water further from my chest. 

Take note of where the buoys are. Don't mistake them for other swimmers (even if at first they seem more conversational).

  Based on your acclimatisation training, you will know how long your body can cope with the cold water. You can set a timer on your watch to make sure you don't swim for too long past your comfort zone. Since the effects of hypothermia become evident after 30 minutes, I would suggest keeping your swim between 10-15 minutes. If you swim for more than that, it's because you are very well trained, fully cold adapted and/or superhuman.

9. Post-Swim After-Care 


     Once you've decided that enough is enough, get yourself dry and into warm clothes as soon as possible. Or, if you've been to more than one of these open water swimming events, take an unusually long time to find your underwear and clothes (you'll certainly not be alone). Especially if normal, sane people passing by are wrapped in five coats and six scarves. They will be incredibly amused by your mostly nakedness.

'Hey check out my new Dry Robe' - First open water swimmer.
(Image from Pixabay.com)
NB: Quote may or may not be real.

     Then, reward yourself with a menu fit for aquatic royalty! Cold water swimming (as with any strenuous exercise) can put pressure on your body's immune system for a couple of hours following your activity. Before, during and after being in cold water, it's best to eat as well as you can and take it easy once you're warmed up. Everyone's diets are different, but to give you some ideas, my suggestions for a 'Cold Water Swim Day' menu are listed at the bottom of the page.

10. Appreciate The Benefits of Cold Water Adaptation


    Apart from feeling pretty smug for an hour or so, the benefits of subjecting yourself to bracing water conditions (if done sensibly) include long-term improvement of the immune system, weight loss, reduced inflammation, better resilience to oxidative stress, an increase in insulin sensitivity and enhanced mental health. Repeated cold water immersions can increase metabolic rate and also the production of white blood cells, resulting in a strengthening of the immune system.

    That increase in metabolic rate may be a result of raised brown fat activity in response to cold adaptation. Brown fat metabolic activity has been linked to non-shivering heat production (also known as thermogenesis) as well as weight loss.

    Furthermore, dopamine, serotonin and endorphins are increased after cold water swimming, leading to improved mood. A case report from the BMJ suggested that it may even be an effective treatment for depression
 
Figure from Tipton, M.J., et al. 2017. Cold water immersion: kill or cure? Experimental Physiology. https://doi.org/10.1113/EP086283

    Cold water immersion has also been reported to ease muscle damage and reduce inflammation after strenuous exercise, although the mechanisms by which this occurs are unclear. Swimming in cold water results in oxidative stress, but repeated winter swimming sessions can provide people with higher levels of blood glutathione and increased activity of superoxide dismutase and catalase enzymes. All these effects lead to improved tolerance to the environmental oxidative stress that can contribute to aging.  

Also it's the only way that hyperactive Type A's can relax sometimes...

    If you're a fortunate person, cold water swimming also makes you feel incredibly grateful for hot running water, warm food and central heating. Gratitude in itself is one small step on the road to better mental health as it can help you focus on the positives of the present moment. Cold water swimming may not be for everyone, but it has certainly helped me cope with the sad month of January. So, if I've convinced you to give it a go, stay safe, have fun and enjoy the boost from your adaptive thermogenic body-confidence!

Warmest thank-you's for reading!

My Cold Water Swim Day Menu:


Pre-Swim Breakfast Menu:


Try not to over-eat and avoid foods which will upset your stomach (especially if you're gluten intolerant, lactose intolerant, have IBS or are allergic to healthy foods). However, your body will thank you later for being sensible regarding your carbohydrate, protein, vitamin and mineral uptake.    
  1. Option One: Wholegrain cereal with mixed nuts, raisins, strawberries, blackberries and bananas with honey, almond milk, soy milk or yoghurt.
  2. Option Two: Peanut butter on wholegrain bread with apple (or other fruits like raspberries and bananas) with honey + yoghurt or glass of soy/almond milk.
  3. Option Three: Homemade mince pies (yes, you can make them healthy..if you want to).
  4. Option Four: Poached egg on wholegrain toast with tomatoes and mushrooms + yoghurt or glass of soy/almond milk
Healthy food can taste amazing and provide you with the energy you'll need for your upcoming war with the elements.
(Images from Pixabay.com)

Daytime Menu:


Again, eating light is key. You want to top up your energy and protein whilst also not overloading your digestive system and making yourself too tired.

  1. Mix of seeds and nuts, including pumpkin seeds, flax seeds, brazil nuts, walnuts, pecans, cashews.
  2. Home-made granola bars (inspired by half-marathon-running 'energy being' Gurp
  3. Thermos flask with a warm drink.

Nuts and seeds are a fantastic source of magnesium, potassium, iron, vitamin B6 and calcium. If you want to feed any water birds who have kindly become your swimming buddies, seeds are preferable to bread anyway.
(Images from Pixabay.com)

Post-Swim 'Rescue Menu' 


Here you want to boost your immune system and help repair your muscles with decent amounts of protein, vitamins, minerals, carbohydrates and healthy fats.

  1. Main Meal Option 1: Wholegrain pasta with spinach, broccoli, carrots, mushrooms, eggs, soy beans and cheese (add salmon or seafood).
  2. Main Meal Option 2: Fajitas with wholegrain tortillas, brown rice, guacamole, bell peppers, tomatoes, cheese. Make the guacamole with avocados, lime juice, tomatoes, chillies, garlic and coriander. 
  3. Dessert: Yoghurt, pineapples, strawberries, clementines, kiwi fruit and bananas. 
  4. If you're still not full, perhaps you'll want more mince pies? (You can eat them at any time of the year, they're amazing and also... who needs approval from society's food police!?)

Left: Guacamole was first invented by the Aztecs, possibly gifted to them by the the majestic God of Water Tlaloc, who knew how essential good nutrition was for wild swimmers. Right: Pasta with seafood - one of my favourite 'after-swim rescue' meals, perhaps combining low-release carbohydrates with something you've caught from your cold-water swim! 
(Images from Pixabay.com)

    

Sunday 25 November 2018

Drowning First Aid

Introduction


As my blog promotes swimming, underwater photography and the aquatic lifestyle, it would be irresponsible of me if I didn't post something about first aid for drowning.
    This will be one of the most serious blog posts that I will ever write and I'm sure that much of the information here will seem like common sense. However, in an emergency situation, it is very easy for adrenaline and the fight/flight/freeze response to block rational thought. Simple and memorable instructions can help make a difference between life or death. And since 400 people in the UK (4000 in the USA) die from drowning each year, it's worth reading and then re-reading all the information presented here.

Starting with this infographic:

Some images from Pixabay.

D - Danger 


  • Before swimming anywhere, think about potential risks to yourselves and others. Does the sea look too rough? How deep is the water? What is the water temperature? How good is the visibility?
  • If your instincts tell you that it looks too dangerous, why risk it? Wait for a while or postpone your swim or dive for another day.
  • If everything looks safe or you're comfortable with the conditions, do take precautions to limit the risk. The water may change from safe to unsafe whilst you're mid dive.
  • Our relationship with the sea can be as complex as that with other humans. If you find yourself in a destructive situation that can't be solved with a cup of tea and a rational discussion, you have every right to leave the environment. 

The same is true with the sea - there's no harm in getting out, chilling on a rock and waiting for your 'loved one' to calm down. If you have the option to keep safe, it's a much better choice than trying to 'tough it out' and harming yourself in the process

  • If you go diving, it's always best to do so with a trained and competent buddy. It's usually more fun that way anyway. 
  • If solitude is your necessity, or you think there is a risk you could lose your buddy, take a brightly coloured surface float, marker buoy or inflatable boat. This will make it easier for buddies to re-unite, for rescuers to locate you and for boat users to be on the look-out for re-surfacing divers. 


A surface float with a flag and pockets to store your phone in a waterproof case is even better

  • And finally, if you're not a confident swimmer but like to hang out near water (or with your water-loving friends), you may not know what to do if you think that someone is drowning. It's best to alert a life guard, someone who can swim or who has access to a boat. If you can't find someone, try to find a life ring or line that you can throw to them. If you cannot swim confidently, do not try to rescue your buddy.

Left: A 15m throwline. Right: A 72cm life ring.

  • Don't take unnecessary risks. Some people may be daredevils (like these puffins), but it doesn't mean that you should be as well. One person drowning is already bad enough. Two people drowning can end in tragedy. 

R - Response


  • One of the best ways to prevent drowning in the first place is to make sure you keep regular communication with your buddy. 
  • Verbal communication at surface intervals, eye contact when underwater and habitual hand signalling will enable you to check your buddy's consciousness and awareness.

The universal diving hand signal for 'OK'. 
Image from Pixabay.

  • If you're on the shore whilst your buddy is in the water, call to them if you spot any potential dangers such as approaching storms, speed boats, tidal waves, sharks or this swan
  • If your buddy is unresponsive, they may be staying still and silent so as not to startle a turtle they're filming for their next YouTube video. Or, they may be experiencing Shallow Water Blackout, which is a loss of consciousness resulting from a lack of oxygen to the brain after a breath-hold dive (and they are at risk of drowning).

W - Watch


  • Watch your buddy. Drowning never looks as dramatic as it does in the movies. A drowning person may spasm but more likely they will stop swimming, stop responding and possibly begin to sink.

If you need prescription glasses on-land, you should also invest in prescription goggles and/or a prescription diving mask. Good vision will make it easier to spot subtle signs that a person is drowning.

  • Check for bubbles in front of their face, caused by an unwanted exhalation after becoming unconscious.
  • Observe their movements. If your buddy seems conscious but is moving erratically, they may be experiencing Loss of Motor Control (LMC, also known as 'Samba'). LMC is caused by dangerously low oxygen levels in their body. You will need to help them hold their head above the water since they may not be able to do so.    

It may seem like your buddy is head-banging, blowing bubbles and playing underwater air-guitar, but there's a good chance they may have Loss of Motor Control and are at risk of drowning. Only incredibly silly people play aquatic air-guitar anyway.

A - Airway


  • If your buddy is not responding and seems to be experiencing drowning, LMC or black-out, your first priority will be to protect and open their airway
  • Approach them from behind if you can and assist them to the water's surface if they have sunk. Support your buddy's head whilst doing so. If they have exhaled air whilst underwater, cover their mouth with their hand to stop them from potentially breathing in more water until you are at the surface. 
  • At the water's surface and whilst supporting their neck and head, tilt their head back to open their airway. Remove their mask to help them breathe through their nose.

Support your buddy's head and neck and tilt their head backwards to open their airway. 
Photo from Cliff Etzel at deeperblue.com

  • Remove any weights they may be carrying. You want to prevent any chances of them sinking back underwater (and re-obstructing their airway).
  • If the water is very unpredictable or there are other aquatic hazards, prioritize getting out of the water. You can't maintain your buddy's airway if you are both in Danger.

T - Talk  


  • Talk calmly to your buddy whilst maintaining their airway at the surface. Unconscious people are usually still able to hear. Encourage them to breathe, use their name, ask them to talk to you. 

Communicating with your casualty is an often forgotten but very important aspect of first aid. 
Image from Pixabay.

  • You can also gently tap their shoulders and breathe softly across their face. Engaging their senses may bring them back to consciousness - the feeling of air across their face can also encourage them to breathe.  

E - Exit the Water


  • If you're still in the water at this point, your buddy is at risk of breathing in water and both of you are at risk of suffering from hypothermia, especially if the water temperature is low. 
  • Whilst maintaining your buddy's airway, do your best to get the both of you out of the water. If you are not near a shore, hopefully you will be near a boat or a platform. 

A boat is better than rocks, but rocks are better than nothing. 
Image from Pixabay.

  • If you're far away from the shore and don't have access to a boat, hopefully you will be near a surface float or marker buoy. Be near anything that can help you to steady yourself whilst you're supporting your buddy and importantly, to make you more visible to rescuers. 

R - Rescue Breaths


  • If your buddy is still unconscious and not breathing, administer five rescue breaths.
  • It can be difficult to tell whether someone is breathing or not whilst they are unconscious. Watch their chest to see if it is rising and falling as they inhale and exhale. You can place the back of your hand in front of their mouth to feel whether or not any air is being exhaled. 
  • It's much easier to apply rescue breaths outside of the water but if you are still in the ocean and waiting for help, administer them anyway. Sometimes you have to work with the situation at hand.

Tilt your casualty's head back with one hand on their forehead, lift their chin with your other hand, pinch their nose and breathe into their open mouth. Do this five times. 
Image from Alpha Outpost.

  • If you're still in the water, administer a rescue breath every five seconds if they are not breathing. 

A - Airway (Assistance/Ambulance)


  • After applying rescue breaths, it is very likely that your casualty will cough up water. Monitor your buddy's airway and make sure it is not blocked by water or vomit. 
  • You may want to briefly lie the casualty so that their head is lower than their body to help drain any water from their mouth.
  • Put your ear to your casualty's mouth to check for breathing.

Keep their airway open with one hand on their forehead, and the other underneath their chin.
Image from Pixabay.

  • If there are other people around, call to them for help. Ask them to call for an ambulance (999 in the UK, 112 in the EU, 911 in the USA).
  • If you're out of the water but there's no one to help you and your casualty is still unconscious and not breathing, administer CPR (see below) for one minute before attempting to call for emergency help. 

B - Breathing


  • If you are still supporting your casualty in the water and waiting for help, keep administering one rescue breath for every 5 seconds and continuously monitor their airway for signs of breathing and/or airway obstruction.
  • If your casualty starts breathing but they are still unconscious, place them in the recovery position.

 This is what the recovery position looks like.
Image from Pixabay.

  • Even if your casualty regains consciousness, is breathing normally and they assure you that they're OK, they will still need medical attention. If any water has entered their lungs it can irritate their air passages and call them to swell (this is known as secondary drowning).   

C - Circulation (CPR)


  • If you are out of the water and your casualty is still not conscious and not breathing, administer CPR (cardio-pulmonary resuscitation).

Place one hand on your casualty's chest, interlock your other hand and with straight arms press down 30 times (these are chest compressions). A first aid training manikin can help you understand how much force is needed when carrying out chest compressions.
Image from Pixabay

  • Carry out 30 chest compressions and then 2 rescue breaths. Repeat until emergency services arrive.
  • How fast should you carry out the chest compressions? Bring to mind 'Staying Alive' by the Bee Gees. It has the perfect tempo and the subject matter is very relevant. 
  • If you have bystanders nearby and you're tired from carrying out CPR for a while, instruct helpers on how to administer it.
  • Depending on how well funded the emergency services are in your area, you may want to keep track of how long it will take for an ambulance to reach you whilst others are helping you with the CPR.
  • If it is available, use a defibrillator and follow the instructions and voice prompts. Be careful not to be in contact with the casualty whilst the defibrillator sends a shock.

Additional Considerations


  • If your casualty has recovered, there is a good chance they will need to be treated for hypothermia. If possible, replace wet clothing with dry clothes and use warm coats or blankets to cover them.
  • If they are conscious, a warm drink may help them. Make sure to keep monitoring their response levels, breathing and pulse. 

To reward you for reading this rather serious post, here is a photo of a dog wrapped in a blanket to illustrate how to take care of someone who is showing signs of hypothermia.
Image from Negative Space.

  • The preceding sections can be summarized as the acronym DR WATER ABC (like DR ABC, but for the WATER) in order to help you keep in mind the order of first aid priorities. 
  • However, the circumstances can dictate the order in which first aid steps are taken or how many times they need to be repeated.
  • The Drowning First Aid Infographic at the top of the page can also be illustrated with seals and sea lions:

Some images from Pixabay.
Image of the sea lion giving CPR is from this video.

  • You can also learn basic first aid from taking workshops and courses at the Red Cross and/or St John's Ambulance. Both are fantastic organisations who do incredible life-saving work all over the world. 


And finally, stay safe and dive with friends. Thank you for reading!