of pulmonary barotrauma was relatively high. Effective management of the airway would be necessary and difficult underwater, and it would be difficult to train divers sufficiently to reliably manage this type of event. They recommended that military divers should be recovered directly to the surface without delay, and that civilian diver training organisations should consider whether this guidance would also be suitable for their use. Making the casualty buoyant on the surface Once the casualty has been brought to the relative safety of the surface, it is important that the casualty does not accidentally sink again. The usual methods of making the diver positively buoyant are to: inflate the buoyancy compensator. This is a routine surfacing drill in some training schemes. inflate the drysuit, if one is being worn. The gas in a dry suit is not very secure; it can easily escape from seals and vents. Also, excess gas in the suit tends to make the legs buoyant causing the diver mobility problems. drop weights. Divers who are out of air will probably not be able to inflate their buoyancy compensator or drysuit using the normal and simple technique of pressing the direct feed injection valve. If their equipment allows it, and this is almost always the case, they may be able to inflate these devices orally or use an integrated gas cylinder (if fitted). Attracting help At this stage in the rescue immediate help is desirable. An immediate call or signal for help may take very little time to get the attention of potential assistance. However, if this fails, the survival of the casualty should be attended to, by artificial ventilation if necessary. Very often, the only people that can provide that help are nearby boat users and people on the shore. Unless the emergency services are very close by or the rescue is beyond the capability of the local rescuers, they will not be on the scene quick enough to be able to provide help. Often with a small group of rescuers the emergency services can only be contacted after the highest priority job of getting the casualty is out of the water has taken place. Often the rescue can be quickened if a boat can come to the casualty rather than a rescuer having to tow the casualty to safety. Once at the surface, using many rescuers becomes feasible; they can communicate and co-operate to make