Panicked diver not exhaling during ascent?

[boulderjohn]

The original question was based on the premise that the breath hold ascent, triggered by panic, was highly likely to embolise, possibly fatally. Does anyone have any idea how likely is likely and how many of those are fatal? ?

If you are a DAN member, download the 2007 accident report and read through the descriptions of the dive fatalities. You will see embolism appearing on quite a few cases.

My nephew's mother-in-law was taking an AOW class and suddenly threw away her regulator and bolted toward the surface. The instructor tried hard to stop her, but hse still made a rapid breath holding ascent.

The autopsy showed that she had had a mild heart attack recently, and that another heart attack had triggered her panic.

But the cause of death was an embolism.

 

[DaleC]

Marinediva, you sound like a nice person and I think this will be the last post by me on the issue as the pertinent points have been made but I just want to clarify the fact that we seem to be discussing two different things and may, or may not, have to agree to disagree.

In post #32 you suggest gently touching someone in the solar plexus to make them breath and then go on to clarify that this is for a panicking diver who is not OOA.
OK, I'll go along with that. I never disagreed with that approach, in that circumstance.

I'm saying that (with the information presented in the OP) for one diver to deal with another panicking diver (the cause of which is unknown) by punching/kneeing to the gut/chest is wrong. Not just wrong but arguable criminally so, particularily for a professional, as it violates the "reasonable man" standard. It's a "guess" at the problem in the first place (why the diver is panicking) and a solution that may, in fact, cause much more harm than good. I would like to know which agency/school teaches the actions I am objecting to.

If you stand by your suggestions in post #32 we do not disagree.
If you are supporting the actions I object to, then I guess we do disagree.

I think the question posed to the OP was (as suggested earlier) a trick question meant to illustrate that sometimes there is nothing we can do to help someone in the immediate moment and to consider the dangers of putting ourselves at risk by doing so. It is a simular question put to me many times during my 7 or so years as an IFA/EMT-A.

Either way, I'm sure our discussion has provided some good points for ourselves and others to ponder.

Dale.

 

[tmacdiver]

Greetings to all once again.
The scenario that was presented to me was brought up as an illustration of how important it is to stay in control of the situation when working with ow students. I am completing my dive master training and am involved in displaying skills and then observing the students while they demonstrate the skills. This happening in a swimming pool, not open water. It is quite clear to me how important it is to take hold of the students BC with one hand while they demonstrate the skills, in case they panic and try to bolt. If they do panic and bolt, by having hold of their BC I could at least slow down the ascent and try to calm them down, maybe help solve the problem. Even in a 15 ft pool, if they held their breath while ascending it could result in major trauma. This is why the scenario came up. It was then asked of me: what if my buddie was at 70 feet and panicked...
The scenario was a real question, not so much a trick question. I have learned from the replies here on SB and from the instructor staff at my LDS that I should do my very best to try to get the panicked diver to exhale, possibly by a carefully placed shove to the lower rib area if possible. It might also be that I can do nothing until he/she hits the surface. Clearly, I should avoid injuring myself. I would be of no help to anyone that happend.
The absolute best way to deal with this potential problem is to do everything possible to avoid it in the first place. Stay in control and communicate.
I wanted to say thank you to all the divers who responded to my question. Experienced divers from all over the world; really quite amazing.

Thank you again!
Tom

 

[Katamuki]

Proof of that statement is where? Give me cases where its happened. To be blunt - i don't believe you.

Any sane legal system allows you to justify and show acting to the best of your ability although im happy to admit the USA doesn't have anything bordering on a sane legal system.

Its so sad that you take potshots at the US legal system in response to my post when you dont even realize I am governed by the Japanese legal system --- yet you go ahead and make a huge ASSumption about what you dont even know. Take some time and get educated.

This is from your own country String, not the US and not Japan, and while I am not an attorney I do know how to read. If a law in England has been passed since 2006 that is addressed in this link then great! However, you will probably be the first one to pass the "reasonable man" test before your jury of peers trying to prove you were saving someone and not committing homicide to a fellow diver.

The Link:
House of Commons - Constitutional Affairs - Written Evidence

The most interesting sections...
5. Our concern is that, if one of these first aiders witnesses an accident in the street, they are, these days, faced with a dilemma: do they just walk on by or do they provide first aid.
6. In general the first course of action exposes them to no risk. However the second course presents substantial risk ie that if due to their intervention the outcome for the "victim" is adversely affected, then they are likely to be sued. There are many incidents of this kind eg the injured motorcyclist whose crash helmet is removed, perhaps to provide resuscitation, but who as a result suffers damage to his neck.
7. We would therefore look for a change in our legal system so that it protects such a volunteer first aider, and generally encourages them to intervene rather than walk away.
8. This is, of course, the "Good Samaritan" situation, and in the absence of a Good Samaritan law in the UK (unlike, say the USA or Canada or Germany), we believe that there is an opportunity for Clause I to fill the gap in some way.
9. It is not clear whether the draughtsman of Clause 1 has first aid volunteers in mind at all, and we think he should. The Committee seems to have heard evidence from a number of quarters where the key element in dealing with the situation appears to be good risk management. The problem for first aiders is that they are generally reacting to emergencies which do not provide the opportunity for a pre-meditated risk analysis to be undertaken.
10. One of the difficulties we see with the currently drafted Clause 1 is that there seems to be no attempt to define "desirable activity", with the matter being left to the courts. However we do feel that it would be helpful if the Bill made an attempt to provide a "non-exhaustive" list of the particular "desirable activities" that were contemplated (we would like to see "voluntary provision of first aid" as a prominent example on such a list).
11. We recognise that if first aiders were to have some immunity from potential claims for damages, then the question remains as to who will compensate a victim (whose injuries may have been severely exacerbated). We believe that in such cases there should be a safety net comprised of a no fault compensation scheme. However, we have not as yet considered how such a scheme might be funded.

Feel free to let me know where I missed the points you were trying to make.

 

[Katamuki]

An older paper on legal issues on the same issue..

The Link...
Legal Status of those who Attempt Resuscitation

The interesting part... the second bolded area is where "standards" of any recognized training agency would be used to aid in prosecution of a diver who forcefully pokes, hits or prods another diver in the water...

Although there have been a few cases in the United Kingdom where a claim has been brought against a ÅÓescuer? there have been no reported cases at all where a casualty has successfully sued someone who came to his aid in an emergency. A claim might therefore, in theory, be brought against a rescuer either in the law of trespass on the grounds that his intervention constituted an assault on the casualty, and / or in the law of negligence for a breach of his duty of care towards the casualty. Potentially there could also be liability for assault in criminal law, but this document will concentrate purely on principles of civil liability and claims for compensation. A claim could be brought either by the casualty or, should they die, by their estate, and if the actions of the rescuer led to serious personal injury or death, a very large payment of damages by way of compensation could in theory be ordered by the court.

And a little more...
A claim may be brought against a rescuer for what is commonly known as assault but, more accurately, described as battery. Battery is a form of trespass against the person that is actionable in itself. In other words, in order to succeed in a claim, the victim does not have to show that he has suffered any actual harm, although it would be necessary for him to show this if he was to be awarded any more than a minimal compensatory sum. Battery is the ÅÊnfliction of unlawful personal force upon another? Force, which can include even light touching, is unlawful if the person upon whom it is exerted has not given his consent to it

The accepted defense of a care giver/rescuer...
The first is the defence of ÅÊmplied consent? the justification behind which is that if the person were conscious and able to make a decision, he would consent to the procedure. The second primary defence to any action for trespass against the person is that of ÅÏecessity? The reasoning here is that treatment without consent can be considered lawful if it is given in the best interests of the patient...

One view on samaritan protection...
There has been some controversy about whether this is a defence which does in fact exist in English law. In one famous House of Lords case, however, the judge stated ÅÕhat there exists in the common law a principle of necessity which may justify action which would otherwise be unlawful is not in doubt?

Final analysis of this paper...
There are likely, however, to be limitations on the application of these defences when procedures are carried out by non-professional rescuers and the less well trained the rescuer the harder it may become to justify either defence. It becomes more difficult, for example, to argue that an unconscious person has given implied consent to a (relatively) untrained person performing what is in effect a medical procedure, notwithstanding that the procedure may be straightforward, automated and mechanical. Similarly, it may be harder to argue that treatment by a lay person is in the best interests of the casualty. Only if the action taken by a lay person is, under all the circumstances, ÁÓeasonable and in the best interests of the assisted person, is there likely to be a defence.

Notice that the defense is for a "lay" person. An instructor would then be held to a greater degree of scrutiny and legal exposure and any deviation from accepted training standards would be considered most likely NOT in the best interests of the casualty.

 

[String]

Its so sad that you take potshots at the US legal system in response to my post when you dont even realize I am governed by the Japanese legal system --- yet you go ahead and make a huge ASSumption about what you dont even know. Take some time and get educated.

Where did i specifically say you were from the USA? I just added i think their legal system is completely insane. Than opinion still stands regardless.

I asked for proof that this could get someone sued, you have provided absolutely no proof what so ever, no case reports, nothing. All i can assume from that is you are just making it up or trying to pass opinion off as fact.

Most sane places are not going to sue someone who attempted to rescue someone even if it was done badly assuming there was nobody higher qualified to act on scene at the time. Its trivial to show that embolism is a big risk and trivial to show an action such as a push to the chest can cause exhalation - those are both known proven facts. From there its easily justifiable to anyone that isnt a complete lunatic as a judge (again excludes USA generally) that those 2 facts combined are more than enough justification.

Anyone stating "better to let them die" but not acting just in case you're sued should in my view not be allowed to supervise anyone at all at any level - its an extremely dangerous attitude to have from someone supposedly responsible.

 

[Web Monkey]

Its trivial to show that embolism is a big risk and trivial to show an action such as a push to the chest can cause exhalation - those are both known proven facts.

Embolism is certainly a risk, but "big" (as in frequency) is poorly defined. Most panicking recreational divers end up on the surface, just fine. This probably wouldn't be the case if someone punched them on the way up.

"a push to the chest can cause exhalation" is only true if they happen to be holding their breath, which in all honesty, you can't know within the few seconds it takes for the diver to get out of range.

Anyone stating "better to let them die" but not acting just in case you're sued should in my view not be allowed to supervise anyone at all at any level - its an extremely dangerous attitude to have from someone supposedly responsible.

What people are saying is that no agency (SCUBA or otherwise) teaches this procedure, so if you do it, you're on your own.

Terry

 

[String]

What people are saying is that no agency (SCUBA or otherwise) teaches this procedure, so if you do it, you're on your own.

Terry

Which doesnt actually matter if you can justify it.

 

[seaducer]

Unless the panicked diver is my child, I am not touching them. There really is very little you can do to stop somebody from bolting to the surface.

Hitting someone in the solar plexus is not very easy to do, it is a small target. That said if by some reason you were able to do exactly that, not only would you force all the remaining air out of their lungs, but you would effectively paralyze their ability to breathe. Think knocking the wind out of someone. This is a technique taught in most, if not all hand to hand combat classes.

Point is you are liable to create a bigger issue out of the situation and to boot, you are now going to be considered responsible for any injuries that may occur.

Doctors have to take the Hypocratic Oath, which includes the "First do no harm" bit. I would suggest if you are not 100% certain in how to handle a situation you leave it be, lest you make matters worse by fumbling around.

This whole thread really strikes me as a solution in search of a problem. This particular solution is best left to combat divers trying to subdue enemy combat divers.

It is ok to not be able to help everyone in every situation...

 

[boulderjohn]

Which doesnt actually matter if you can justify it.

When you use industry-accepted methods, the burden is on your opposition to prove that you erred, and that is a losing case because it does not matter if the industry standards are right or wrong as long as you followed them in good faith. The industry standards, not you, will be on trial.

If you take a course of action that goes against industry standards, then the burden will be on you to show that what you did was a proper course of action. This is especially true if you know the industry standards and intentionally violate them.