A Florida EKG monitor technician and recreational diver on the difference between reading a patient with instruments and reading one twenty miles from shore with none.
In a hospital, trouble usually announces itself as a number. A rate climbs. A rhythm widens. Something on the screen stops looking like it did an hour ago, and the person watching that screen picks up a phone.
On a dive boat, trouble announces itself as a look.
Phillip Zmijewski has worked both sides of that sentence. He spent years as an EKG monitor technician in Florida hospitals, watching continuous cardiac telemetry for patients he often never met. He is also a recreational diver who has logged years across the state’s springs, reefs and offshore wrecks, and he holds a Medical Care Provider certification through Maritime Professional Training. The two roles look unrelated from the outside. Zmijewski argues they are the same job performed under opposite conditions, and that the second one is considerably harder.
Two very different kinds of information
Clinical monitoring runs on abundance. A monitor tech has continuous data, a trend line stretching back hours, alarm thresholds set in advance, and a documented baseline for every patient on the floor. The information problem is not scarcity. It is filtering, deciding which of the hundreds of things the equipment reports actually deserves a response.
Offshore, the information problem inverts completely. There is no screen. There is no trend. There is a person who was fine at the surface interval and now seems slightly off, and there is whatever you happened to notice about them earlier in the day.
The clock behaves differently too. In a hospital, escalation is measured in the seconds it takes a team to reach the room. On the water, it is measured in how long the boat takes to get back, which is not a number anyone can shorten once the dive has already happened.
What carries over
Two habits transfer, and Zmijewski says both are underrated by divers who assume medical training is mostly about procedures.
The first is baseline discipline. On a telemetry floor, you cannot identify an abnormal rhythm until you know what that particular patient’s normal looks like. Nobody reads a strip in a vacuum. The equivalent on a boat is knowing how the people you are diving with behave when nothing is wrong. How they talk on the ride out. How quickly they gear up. Whether they are usually quiet or usually not.
“You cannot recognize a change in someone you never looked at in the first place. On the boat, the assessment starts during the ride out, not after somebody surfaces.”
Most divers, he notes, spend the trip out checking their own equipment and looking at their phones. The people they will be responsible for in an emergency are sitting three feet away, unobserved.
The second habit is weighting patterns over single readings. Monitor techs learn early that one unusual complex is usually noise and that a slow drift across twenty minutes is usually not. The same logic applies to a diver who surfaces a little tired, then a little quiet, then a little uncoordinated getting out of their gear. No single one of those is an emergency. The sequence is a different matter.
What does not carry over
Almost everything else. There is no pulse oximeter, no twelve-lead, no lab, no imaging, and no colleague more senior than you to hand the problem to. Offshore, whoever is standing there is the escalation until a radio call reaches the Coast Guard or the Divers Alert Network emergency line.
The most important difference, in Zmijewski’s view, is that the cost structure of a wrong call flips entirely.
Hospitals are built to discourage over-triage. Calling a rapid response for something minor pulls a team away from patients who need them, and every institution applies quiet pressure toward being sure before escalating. That pressure is reasonable inside a building with finite staff.
It is actively dangerous on a boat. The cost of over-triage offshore is a scrubbed dive, an early return and an afternoon that did not go as planned. The cost of under-triage is not recoverable. The threshold for acting should therefore be far lower on the water than it is in a hospital, and Zmijewski says most recreational divers carry it in exactly the wrong direction, having absorbed the cultural instinct not to make a fuss.
The decision is not the diagnosis
The trap he sees repeatedly is divers believing they need to identify what is happening before they are allowed to respond to it. They run through possibilities, decide they are not qualified to distinguish between them, and default to waiting.
“Nobody on that boat needs to name the problem. The only question worth answering is whether this person gets oxygen and a radio call or whether they get watched. You can be completely wrong about the cause and still make the right call.”
That framing comes directly from the monitor role. A technician watching telemetry is not diagnosing anyone. The job is recognizing that something has changed and making sure the change reaches a person who can act on it. Offshore, the recipient of that information is a radio rather than a nurse, but the function is identical.
What this looks like in practice
Zmijewski’s version of preparation is unglamorous and mostly social. Talk to people on the ride out, enough to register how they sound when they are fine. Watch how divers come up and out of the water, not just whether they came up. Establish before anyone splashes who is making the call if something looks wrong, the same way a boat briefing assigns every other role. Confirm the oxygen is aboard, accessible, and that more than one person knows how to deploy it.
None of that requires a certification beyond what a well-run charter already expects. It requires deciding in advance that observation is a job somebody is doing, rather than something everyone assumes someone else is handling.
The same skill, stripped of its equipment
The instinct is to treat the hospital version as the sophisticated one and the boat version as improvised first aid. Zmijewski thinks that is backwards. The monitor makes the work easier by supplying data that would otherwise have to be inferred. It does not make the work different.
Both jobs come down to knowing normal well enough to notice its absence, and being willing to act on that noticing before certainty shows up. The screen is a convenience. Offshore, when it is gone, what remains is the part that was doing the work the whole time.
