Advanced Open Water Certification

[TMHeimer]

Jim, Thanks for the detailed descriptions. I like the SEI OW requirements better than NAUI's. These are the skills I have always felt should be in all OW courses. Some may (have) argued that these skills are too much to throw at the OW candidate (without seriously lengthening courses, costs, etc.). I would think that it is better to have new OW divers who have had this rescue training, even though they are still obviously polishing their basic diving skills. The rescue skills will be there when they need them, and can always continue to practise them as they become more experienced divers. I advise OW graduates to seek rescue-experienced buddies if at all possible.

I would also agree that once a diver reaches rescue level in all agencies, how good the course is would depend on the instructor, figuring the skills are the same regardless of agency.

 

[KevinNM]

Unless you have an observed collapse followed by effective CPR and rapid ALS response the outcome from CPR is going to usually be bad under any circumstance. However at the point where you are starting CPR the victim is dead, so there is no possible way you can make the situation worse. So it's important for students to know that if you have to administer CPR the odds are that this is not going to have a TV ending no matter how effectively they do it. But it is still worth trying.

 

[TMHeimer]

Unless you have an observed collapse followed by effective CPR and rapid ALS response the outcome from CPR is going to usually be bad under any circumstance. However at the point where you are starting CPR the victim is dead, so there is no possible way you can make the situation worse. So it's important for students to know that if you have to administer CPR the odds are that this is not going to have a TV ending no matter how effectively they do it. But it is still worth trying.[/QUOT




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Yes. I have read that CPR only circulates blood to 1/3 of where it normally goes, but you keep doing it until paramedics arrive. Recently, it has been changed to giving chest compressions before 2 rescue breaths. Not sure why this change occurred only a couple or 3-4 years ago, as they certainly must've had years or decades of data saying this way is better -- given the last 20-30 years of technology.

 

[Basking Ridge Diver]

Yes. I have read that CPR only circulates blood to 1/3 of where it normally goes, but you keep doing it until paramedics arrive. Recently, it has been changed to giving chest compressions before 2 rescue breaths. Not sure why this change occurred only a couple or 3-4 years ago, as they certainly must've had years or decades of data saying this way is better -- given the last 20-30 years of technology.

From the American Heart Association - you can also do hands only CPR - Compressions are what is keeping the blood flowing.
Rescue Breaths

A change in the 2010 AHA Guidelines for CPR and ECC is to recommend the initiation of compressions before ventilations. While no published human or animal evidence demonstrates that starting CPR with 30 compressions rather than 2 ventilations leads to improved outcomes, it is clear that blood flow depends on chest compressions. Therefore, delays in, and interruptions of, chest compressions should be minimized throughout the entire resuscitation. Moreover, chest compressions can be started almost immediately, while positioning the head, achieving a seal for mouth-to-mouth rescue breathing, and getting a bag-mask apparatus for rescue breathing all take time. Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression (Class IIb, LOE C).^52–54
Once chest compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag-mask to provide oxygenation and ventilation, as follows:

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In 2010, ILCOR (International Liaison Committee on Resuscitation), reviewed hundreds of studies and found that breathing just wasn’t necessary for people when doing CPR. Even for advanced medical personnel, like paramedics and doctors, breathing for someone in cardiac arrest has a limited role. The science behind this seemingly huge shift in treating someone has been around for over a decade, but it has only been recently that people in the U.S. have been paying attention (many European countries changed their recommended method well before the United States).

CPR Does Not Require "Mouth To Mouth"

 

[RJP]

The most challenging skill is bringing an unconscious, non-breathing diver to shore while stripping both that diver and yourself of all equipment and providing continuous mouth to mouth resuscitation. I wonder how often that skill has been used in real life, and I wonder how often it has led to the revival of the victim.

I'm 2-for-2 in these scenarios. Sort of... as I didn't do mouth-to-mouth in either case. First time was while crewing on a boat in the ocean, second one during an OW class at Dutch Springs. In both cases - as Jim points out above - it was clear that it was more important to get the victim on the boat/to shore so that effective aid could be rendered. In the first case there was such a strong current that if I stopped to give breaths I never would have made it back to the boat. At Dutch Springs we were maybe 150 yds from shore with EMTs, O2, etc waiting for us so the decision was to haul-ass to get there.

The first victim left in a helicopter, the second in an ambulance... and both are walking around today.

 

[dberry]

While I agree with most of what you had to say, my experience in the Florida Keys is that most shops don't worry or care about your experience or ability if you pay the fees.

FWIW, last month Rainbow Reef in Key Largo wouldn't book my dive buddy for the Spiegel Grove since he didn't have a AOW card, until he mentioned we were diving with an instructor / guide. We both thought this was a reasonable and responsible attitude by the dive op.

 

[Jim Lapenta]

It also didn't seem to matter in the swims we did. One or two person, you still had to stop the tow to attempt breaths. Trying to do it while underway pretty much guaranteed you would not be effective. The other somewhat ridiculous method, at least today that is still at least mentioned is using the snorkel to deliver breaths. While shops try to market dry and semi dry snorkels instead of simple j tubes. Either make sure the students know how worthless those are for the skill, take it out of the class unless they have a j tube, or stop selling gimmicky snorkels as being appropriate for divers.

 

[Redshift]

Do your breaths!

The recommendation for not doing rescue breaths is for untrained people. 30:2 is both on the American Heart Association and European Resuscitation Council guidelines. They do emphasize the importance of compressions and in not wasting any time, so rescuers have to be proficient and minimize the times when compressions are not being done. That is during ventilation, defibrillator use, etc. And of course it becomes much better when there are more than one rescuer.

From AHA 2010, Adult Life Support, page 307:

"Treatment Recommendation
All rescuers should perform chest compressions for all patients in cardiac arrest. Chest compressions alone are recommended for untrained laypersons responding to cardiac arrest victims. Performing chest compressions alone is reasonable for trained lay persons if they are incapable of delivering airway and breathing manoeuvres to cardiac arrest victims. The provision of chest compressions with ventilations is reasonable for trained lay persons who are capable of giving CPR with ventilations to cardiac arrest victims. Professional rescuers should provide chest compressions with ventilations for cardiac arrest victims. There is insufficient evidence to support or refute the provision of chest compressions plus airway opening and oxygen insufflation by professional rescuers during the first few minutes of resuscitation from cardiac arrest."

Furthermore, these guidelines did not update the previous 2005 guidelines with respect to drowning victims where ventilation is important and that we may also encounter while diving!

Also, we need to have in mind that many of these studies involve field work in situations where advanced care is more accessible or the rescue is already being done by advanced care units on their way to hospital. If a diver is on a boat, how helpful are compressions after 10 min without any oxygen left?


AHA here Emergency Cardiovascular Care
ERC here https://www.erc.edu/index.php/doclibrary/en/209/1/
Both of these and others can be found via ILCOR Ilcor - Home

 

[Jim Lapenta]

Breaths are fine WITH compressions. How do you do compressions with breaths while towing in water?

 

[Basking Ridge Diver]

For me - if I don't know you - you are getting CPR only - no breaths (without a barrier or bag). I understand your point - but for me and my piece of mind - I will back off and gladly let anyone else take over...
I am not rescue certified - I am CPR certified as a FF - but I see enough blood borne pathogens and hazmat issues to be more concerned about me and my health.