GENERAL REGULATIONS - CHAPTER 2
Health and safety
2.1 MEDICAL INFORMATION
(Personal and medical information) The undersigned acknowledges that the sentences indicated by letters A to H represent an exchange of information between the parties and therefore declares to be aware of the need to read them carefully and understand them. The participant also declares to have been informed by the staff of the Hotel Terme Millepini and Y-40® that: “if one of the psycho-physical conditions, infections, pathologies, illnesses, interventions, situations and/or states described and indicated by the letters from A to H, he is obliged to inform the Management or the reception staff before starting any type of activity, in full awareness that diving and activities can be dangerous for his health and in the most serious cases even lethal. In the aforementioned cases, the activities are strongly discouraged unless preceded by specific medical advice. The false, reticent or inaccurate information provided, as well as the omission of the requested information regarding one’s medical history and one’s psycho-physical state could expose one to serious health risks”. Therefore during the activities:
(A) Is in good physical and mental condition; can swim independently and is comfortable in deep water; (B) He is not in a cold, constipated state or with ear or respiratory tract infections and therefore is able to carry out the compensation maneuver without impediments. (C) Has no problems with: asthma, emphysema, tuberculosis, respiratory disease or any other form of lung or bronchial infection and/or disease; of ear diseases or operations; infections or other problems in the frontal sinuses; heart disease and cardiovascular diseases. (D) Before the activity you have not ingested any foods that advise against entering the water and you have not taken alcoholic or intoxicating, pharmaceutical or psychotropic substances or any other medicinal products. (E) You have not undergone heart, lung, back or spinal surgery or in any case you have not undergone any type of surgery in the last year. (F) You are not in one of the following conditions and/or pathological states: diabetic; pregnant (in case of scuba diving/freediving); regular intake of medicines; high cholesterol level; illnesses or pain in the back or hernias; (G) Has no history of heart attack or stroke, heart disease or hypertension, bleeding or coagulation disorders. (H) Does not suffer from behavioral disorders, claustrophobia, agoraphobia, epilepsy, anxiety and panic attacks, loss of consciousness or fainting, nervous system disorders. The participant undertakes to provide all personal information relating to the personal health and medical condition in a truthful manner, reporting to the Management or reception staff any information (regarding points A to H) that may be useful to guarantee the protection of his psycho-physical state; the Management invites you to communicate personally or via email (info@millepini.it or info@y-40.com) any information relating to your health that may be useful to guarantee the safety and protection of your person.
(Intervention 118) The Management, not being able to carry out the medical diagnosis activity, reserves the possibility at its discretion, to activate 118 and call the underwater rescue of the firefighters with the charging of the intervention costs to be paid by the person rescue and/or who caused the accident. Furthermore, the athlete and possibly the instructor will be sanctioned with exclusion from Y-40® activities. They will be able to return to diving following specific medical certification.
(Emergencies and safety) Y-40® will take all necessary measures to safeguard user safety and prevent accidents; in the event of an accident, the instructor or guide must immediately notify the Y-40® Management who will make all the appropriate decisions and manage the rescue according to its intervention plan. In the event of an accident it is necessary to follow the instructions of the Pool Manager. Each diver can be filmed with audiovisual aids for safety and protection reasons. Y-40® remains the exclusive owner of all images taken within it which may be used for safety and security purposes.
(Health emergency – e.g. COVID-19 – personal temperature measurement) By signing this regulation the participant authorizes, during the “COVID-19” health emergency period, Millepini Immobiliare S.r.l. and Y-40 The Deep Joy S.S.D. to R.L. to the processing of medical data and to carrying out, during the period of stay at the facility, health tests for verification and temperature measurement by those responsible for the activities in compliance with current legislation (e.g. regarding covid-19). We inform you that medical data falling into particular data categories are processed in compliance with EU regulation 679/2016. The detailed information on our website or in an attachment to the email we sent. Consent to processing is necessary both to manage the activities and services we provide and to ensure that this occurs in compliance with the safety indications provided by the Scientific and Health Authorities.
2.2 SAFETY WARNINGS FOR DIVING PARTICIPANTS
(Compliance with standards) The activity of a diver using cylinders (ara/aro systems) or in freediving, if not carried out according to the standards of educational agencies and those of good diving technique required by UNI regulations, entails risks to one’s health. Any exceeding of altitude beyond the limits allowed by your patent can cause even very serious dangers to your health.
(Apnea and Scuba on the same day) It is dangerous for health and therefore prohibited for the diver to carry out freediving and scuba diving activities on the same day.
(Decompression diving) Planned decompression diving is prohibited.
(Hyperbaric environment) Y-40® also informs that during the dive the diver/freediver exposes himself to risks related to compression and decompression of the body. With compression there may be difficulty compensating for the increased external pressure in the ears, sinuses, teeth and lungs. This can cause pain, extravasation of fluids into these spaces, hearing loss and/or inflammation of the ears or paranasal sinuses. These problems usually resolve themselves within a few days. Permanent problems, such as inner ear trauma (dizziness and hearing loss), rarely occur. The diver must immediately report any discomfort during compression to the dive manager/supervisor. The compression will be stopped until you have a chance to compensate and the medical staff is notified. If this happens in the water, it is recommended that you go back up and discuss whether to continue with your manager/supervisor.
(Other risks associated with exposure to increased atmospheric pressure) Exposure to high partial pressures of nitrogen may cause a feeling of dizziness or inebriation, known as nitrogen narcosis. This sensation is not painful and usually resolves immediately as soon as you ascend above 20 m. Exposure to higher than normal partial pressures of oxygen can cause seizures.
(Travel at high altitudes) Always check the no-fly period at the end of the dive, in case you need to take a plane or go by car to mountain passes. If you have gone diving, please remember that it is strongly advised against traveling by plane or in any case going to high altitudes for the next 12 hours.
(Scuba – Decompression Illness – PDD/DCS) As pressure decreases during and after decompression or ascent from the bottom, symptoms such as joint pain, muscle weakness, dizziness, paralysis, hearing loss, vision changes or problems may occur. cerebral. These problems are part of the so-called Decompression Illness (PDD). DCI can cause brain, spinal cord, inner ear damage, disability and death. The first symptoms of Decompression Illness may be joint pain, skin rashes or headaches. DCI is treated with re-compression and hyperbaric oxygen. If treatment is carried out as soon as possible after the onset of symptoms, they usually resolve completely. However, recovery may not be complete and pain, weakness, or other neurological problems may persist, even after adequate treatment. If symptoms appear during or after the dive, Y-40® Management and the 118 call center must be notified immediately. Decompression can also cause lung injury (Pulmonary Barotrauma, with possible collapse of the lung and pneumothorax) . This may require immediate medical or surgical intervention, and/or cause gas bubbles to pass through the arteries that supply the heart, brain or other organs. Heart attacks or cerebral strokes (due to arterial gas embolism) may occur with the possibility of serious disability. This is extremely rare in divers who ascend breathing correctly after diving in water or compressions in a hyperbaric chamber. A further possible long-term damage is dysbaric bone necrosis (aseptic necrosis), similar to arthritis, affecting large joints (shoulders, hips, knees). This condition can be painful and sometimes requires the surgical implantation of artificial prostheses.
(Apnea – Temporary or permanent damage to health) Loss of movement control (samba/CML), black out, taravana, fainting when exiting a dive, and any other type of event that causes temporary or permanent damage to health, for safety reasons, requires, at the sole discretion of the lifeguards or Y-40® instructors, immediate exit from the water and the end of the diving session. Furthermore, the athlete and possibly the instructor will be sanctioned with exclusion from Y-40® activities. They will be able to return to diving following specific medical certification.
2.3 ILLNESS RESPONSE PROTOCOL Y-40 POOL / HOTEL TERME MILLEPINI, POOL AREA
By Dr. Matteo Paganini Specialist in Emergency and Urgency Medicine OMCEO AP3197
The flowchart following this document (ver 2/2023) aims to define the assessments and actions in carrying out assistance to a person who has fallen ill in the vicinity of the Pool Area of the swimming pools in the Y-40 and Hotel Millepini complexes. It does not describe response procedures to urgent health emergency situations that occur outside these areas (for example, but not limited to: bar and reception area, classrooms, changing rooms, solarium, car park), even if it represents an example of a potential response to situations emergency in other environments where there is or is not a body of water.
The Lifeguard Assistant, among the various tasks envisaged, is responsible for monitoring the safety of people using the swimming pools and the Bath Area, and intervenes in the event of illness as an event manager. The Lifeguard Assistant possesses the relevant requirements and qualifications in force both for rescuing people in the water and for recognizing the symptoms of decompression sickness and administering oxygen to the person who is a victim of suspected decompression sickness.
The illness can be reported by any person: instructors, employees or collaborators, or users of the swimming pools. The alarm must reach the Lifeguard Assistant immediately and without delay. Once the lifeguard reports an illness or becomes aware of a person’s illness, the Lifeguard activates the health emergency procedure as described below.
1) activate via radio (or have it activated by delegating) the receptionist of the respective facility, specifying whether ill at the Y-40 pool floor or Hotel Millepini;
2) while waiting for the receptionist to arrive, provide assistance in safe conditions and using the PPE available.
If you feel sick in the water:
- In the event of drowning on the surface or below the surface, carry out a rescue according to the procedures established by the Italian Swimming Federation (FIN), Rescue section, or similar teaching;
- In the event of an underwater accident, carries out rescue according to the rescue procedures (Rescue Diver; Emergency First Response) of the Professional Association of Diving Instructors (PADI) or a similar certifying body in the field of education, assistance and rescue in underwater activities, or collaborates with the underwater rescuer (which according to international teaching is provided by the person paired with the one who has an illness). Diving equipment may be used, previously assembled and placed in the designated area, or the first available equipment deemed suitable for the rescue.
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*The validity of these certifications will be periodically verified by the employer*
The Receptionist, with a process started in parallel with the previous ones, receives the alert via radio and confirms its reception via radio. She takes the medical emergency backpack and the Automatic External Defibrillator (AED), and goes without delay to the pool surface near the rescue scene, immediately interrupting the activities she is carrying out. You will assist the Lifeguard in providing aid out of the water and remaining safe.
3) The Lifeguard Assistant carries out the patient’s Basic Life Support and Defibrillation (BLS-D) assessment, according to the certifications he or she holds (in compliance with DGRV no. 2847 of 29 December 2014) and also drawing inspiration from the First Aid course Company assistance provided according to Legislative Decree 81/08 and Ministerial Decree 388/2003. In particular, after placing the patient safely on the ground, supine (lying on his stomach), he will evaluate the presence of signs of consciousness, breathing and circulation (ABC). In the event of problems encountered even in just one of the three domains, ABC will continue according to the BLS-D procedures and by calling or having the emergency service number 118 called immediately and without delay.
If ABC is present and without alterations, the Lifeguard Assistant will have to evaluate the patient’s symptoms and call or have 118 called, then following the instructions given by the 118 operator on the telephone until the emergency services arrive on site.
In the particular case of a patient who has carried out underwater activities (for example, but not limited to: freediving, SCUBA diving, technical diving), at the same time as calling 118 and asking for confirmation from the 118 operator, the Lifeguard Assistant will be able to administer oxygen in a mask to flows according to procedures already validated by PADI and Divers Alert Network (DAN), if you suspect decompression illness or a pathology related to dysbarism, until help arrives.
Alternatively, the Lifeguard Assistant will also be able to make use of a possible telephone consultation with a Doctor expert in Underwater and Hyperbaric Medicine identified by the Y-40 structure (if present on site or if contacted by telephone).
In the case of underwater activities such as SCUBA diving or technical diving, the symptoms of suspected decompression sickness after scuba diving may be: musculoskeletal pain, skin itching and/or skin rash and/or skin swelling, “patchy” changes in skin sensitivity , changes in sensation or movement, difficulty urinating, pain in the chest, back or abdomen, difficulty walking or coordinating limb movements, dizziness, decreased hearing or a sensation such as “whistling” or auditory “noise”, changes in state of consciousness, vision changes, shortness of breath, cough, syncope and fainting, headache, tiredness / lack of strength. Severe symptoms usually develop within 1 hour of resurfacing; 99% of symptoms generally occur within 6 hours of resurfacing, but they can also appear up to 24 hours after an underwater activity [1].
Even in the case of apnea, problems related to changes in environmental pressure can occur: fainting underwater (black-out); neurological symptoms as already described in the previous paragraph, or generalized or isolated seizures in one body sector (samba); barotrauma
pulmonary with or without hemoptysis (lung squeeze) [2].
It should be remembered from the literature that one of the main problems inherent in the rescue of a dysbaric accident is the lack of recognition of the symptoms or signs of decompression illness, both by the patients themselves and by those providing the rescue. The consequence of this lack of recognition is the delay in alerting and initiating specialized rescue services and, often, the initiation of inadequate rescue and treatment procedures, from which this document arises.
For this reason, DAN recommends, in the event of a correlation between signs and symptoms and recent diving activity, to still suspect a dysbaric accident and to administer oxygen at high concentrations, already at the scene of the accident and while the medical emergency services are alerted [3] .
Italian legislation, in fact, requires that operators carrying out recreational diving activities must have available “a unit for the administration of oxygen with characteristics compliant with the EN 14467 standard” [4]. And in this sense, the Lifeguard Assistant can administer
oxygen in case of emergencies by virtue of a note of clarification from the Ministry of Health [5] also referred to by the Veneto Region [6] and by the diving accident management protocol drawn up by the Regional Functional Department of the Urgency and Medical Emergency Service of the Veneto Region [ 7]. In the above it is also recommended to use the oximeter (present inside the emergency backpack) as an aid in the use of oxygen.
At the end of the event, the Lifeguard Assistant will have to draw up a report addressed to the employer about the event, detailing all the phases of the response protocol with also indicated timing and actions taken.
Bibliography:
- 1) Mitchell SJ, Bennett MH, Moon RE. Decompression Sickness and Arterial Gas Embolism. N Engl J Med 2022;386:1254–64.
- 2) Divers Alert Network. Emergency Oxygen for SCUBA Diving Injuries Student Course Manual 2021.
- 3) Bosco G, Rizzato A, Moon RE, Camporesi EM. Environmental Physiology and Diving Medicines. Front Psychol 2018;9:72.
- 4) Ministry of Transport Decree – 07/29/2008 – n. 146 – Regulation implementing article 65 – article 90 paragraph c
- 5) Ministry of Health, Department of Service Planning and Organization
National Health. Emergency Oxygen Administration – DGUFSC 0018981-P-
03/207/2012. - 6) Veneto Region, Health Planning Implementation Directorate: Oxygen administration in emergency. Prot. 357350/64.00.03.01.00 of 02 August 2012.
- 7) Veneto Region. Regional Functional Department – Urgency and Medical Emergency Service. Diving accident management protocol. Official Reg. AULSS3 U.0040084 of 02 March 2022.
2.4 ACCESS TO ACTIVITIES DURING HEALTH EMERGENCY OR EXTRAORDINARY EVENTS OR FORCE MAJEURE
(Closure) If the Administrative Authority were to issue measures ordering the closure of the plant, the Management will refund the purchase price by sending a voucher with a validity of 365 days from the reopening date or by the date indicated on the document. The voucher request can only be submitted after the date of the booked entry.
(Lockdown) If there is a total blockage of circulation or services for reasons related to emergency situations regulated by the administrative authority (for example: lockdown for Covid-19), by Italian or foreign institutions, the services purchased will be refunded by means of a voucher with validity lasting 365 days from the reopening date or by the date indicated on the document. The voucher request can only be submitted after the date of the booked entry.
(Personal Restrictions) Should you incur personal restrictions for health emergency reasons or for investigations carried out by Italian or foreign institutions, the services purchased will be reimbursed by means of a voucher with a validity of 365 days from the date of reopening or by the date indicated on the document. The voucher request can only be submitted after the date of the booked entry and the voucher will be sent following receipt of the medical certificate relating to the limitation.
