Rescue Questions

[wve]

I have been reading my rescue book waiting for it to get a little warmer for class, and had a question on the ascent, I know I have to go up at a safe speed, but if there were people on the surface near enough to where the distressed diver would "pop" could I send him up "express" I just finished EFR and seems that not breathing = no heartbeat ~= dead. no heartbeat / breathing then no Nitrogen exchange no reason to go up slow might as well pop the top. also if there is any chance he can breath on his own at the surface faster is better. better to be alive in the deco chamber than dead. fully inflate his BC and let go?

A couple of thoughts from a medical standpoint:

First, sending a non-breathing diver up "express" risks lung over expansion, especially if the airway is blocked. This, in turn, could render it difficult, if not impossible, for the victim to adequately ventilate -- even if he started breathing on his own.

Second, although brain cells start dying within minutes when deprived of oxygen, drowning victims seem to have less problem with this. I once cared for a young drowned victim who had been unconscious underwater for 40 minutes. She was comatose when she reached the hospital, but over the next few days, she awoke without any detectable effects. Obviously everyone is not so lucky, but you might be surprised how long drowning victims can stay down and still recover.

I agree with those who advise making sure you control your own ascent so that you don't become another victim.

But I am also saying here that just because there is no breathing, it doesn't mean the victim is as good as dead. The object is to give him a chance, and try NOT to make things worse by inducing further injury.

 

[SailNaked]

Im not medical. I would think that either the airway is open or closed and will not liklely change on the way up. If the gas is going to blow out your lungs it may do so if you come up slow. I guess it would be up to the breathing diver to assess the risk, at 60 ft /min then we are only talking 2 min max for rec limits, at 30ft/min lots more. however permanent brain dmg starts at about 3 or 4 min. Assuming CPR is effective at the surface.

The amount of overpressurized gas in the blood will not change with a non breathing /circulating victim and thus will come out of solution at the surface. Really the only good senerio would be to have a chamber at the surface and do cpr in it.

I think my answer to this question for myself would be that i would come up at 60ft,min with the diver in tow and pray for a miracle.

 

[boulderjohn]

I think my answer to this question for myself would be that i would come up at 60ft,min with the diver in tow and pray for a miracle.

The concept is good, but remember something about it. If the diver was reasonably close to neutrally bouyant before passing out, then as you ascend that diver will eventually be towing you. That's why the knees-on-the-tank position is helpful. You have access to both your inflator hose and the victim's inflator hose for control. We can start a real debate (and I have seen them) over whether you should use your inflator or the victim's for your primary control, but I like the idea of having access to both. If you are diving in tropical waters with a 3 mm wet suit, you probably don't have a whole lot of air in the BCD to begin with, so dumping it all is not going to help that much good for stopping a bouyant victim's ascent.

 

[don Francisco]

One thing to note is that airways are not digital, ie not always either fully open or fully closed. The airway can be partially obstructed, or partly closed, or there could be some lung congestion, so a reasonable ascent rate would reduce the chances of an expansion injury, though with an unconscious diver there are no gaurrantees.

A few seconds wasted on a controlled ascent make a good tradeoff for a better chance of rescusitation at the surface.

 

[wve]

One thing to note is that airways are not digital, ie not always either fully open or fully closed. The airway can be partially obstructed, or partly closed, or there could be some lung congestion, so a reasonable ascent rate would reduce the chances of an expansion injury, though with an unconscious diver there are no gaurrantees.

A few seconds wasted on a controlled ascent make a good tradeoff for a better chance of rescusitation at the surface.

Exactly.

If the victim's head is down (chin on chest) -- which is the natural position a head tends to drop to when one goes unconscious -- then the airway will be mostly closed. If you could tie the head back with the trachea straight, then the victim might survive a rapid ascent because the lung pressure could equalize to the outside. But in the time you spent figuring out how to do that, you could have just taken them to the surface yourself in a more safe, controlled fashion.

In a true emergency where a rapid ascent is contemplated, worries about barotrauma should supersede concerns about nitrogen.

 

[Crowley]

split decision - is it better to be bent or dead?

When I teach rescue - surfacing the unresponsice diver (I'm a PADI instructor) I always teach that it's better to use the victim's BCD for buoyancy rather than your own. This way if you should get separated then they will float and you are in control. If you do it the other way around and you get separated - then you might have a rapid ascent and they sink - not good.

An unconcious person is incapable of holding their breath, so a rapid ascent for that person (excluding any other blockage) is unlikely to result in a lung over-expansion injury, as long as you maintain an open airway. Most drowning victims do not recover.

So that's a choice yo have to make - better to be seriously injured or dead?

Agree wholeheartedly with most of the sentiments in this thread - (1) look after yourself, (2) undertand the medical repercussions between DCS/DCI and drowning and (3) hope it never happens

Dive safe,

C.

 

[Crowley]

split decision - is it better to be bent or dead?

When I teach rescue - surfacing the unresponsive diver (I'm a PADI instructor) I always teach that it's better to use the victim's BCD for buoyancy rather than your own. This way if you should get separated then they will float and you are in control. If you do it the other way around and you get separated - then you might have a rapid ascent and they sink - not good.

An unconcious person is incapable of holding their breath, so a rapid ascent for that person (excluding any other blockage) is unlikely to result in a lung over-expansion injury, as long as you maintain an open airway. Most drowning victims do not recover.

So that's a choice yo have to make - better to be seriously injured or dead?

Agree wholeheartedly with most of the sentiments in this thread - (1) look after yourself, (2) undertand the medical repercussions between DCS/DCI and drowning and (3) hope it never happens

Dive safe,

C.

 

[wve]

An unconcious person is incapable of holding their breath, so a rapid ascent for that person (excluding any other blockage) is unlikely to result in a lung over-expansion injury, as long as you maintain an open airway. Most drowning victims do not recover.

An unconscious person cannot hold his or her breath, but a blocked airway has the same effect.

The OP asked if you could just shoot an unconscious victim to the surface. There are reasons why you might be able to, and there are reasons not to. I was giving a reason why NOT to -- namely, that when the victim goes up on his own, no one is protecting the airway. So it isn't the ideal plan.

It also seemed that the OP was concerned about the 4 minute time limit before brain damage begins to occur. While that is a good rule of thumb, it is not universally true, especially in near-drowning victims. So I was trying to say, "Don't get in so much of a rush that you jeopardize yourself, or that you cause further damage to the victim."

I agree with the instructors' advice about what to do. I'm just throwing in some medical perspectives because someone asked.

Sorry if I made the water more muddy ...

 

[TSandM]

I would think, in the vast majority of cases, the victim is better with a slower ascent WITH you than a ballistic ascent to a surface where no one is expecting him, and no one knows what he is or what he needs when he arrives. If you accompany him, you can do rescue breaths immediately upon arrival at the surface, and try to restart respirations; if this is unsuccessful, you are there to yell for help and get people on shore or on the boat moving to assist. If you send the person to the surface unescorted, he may arrive to chop that keeps his face under the water part of the time; no one will know immediately what to do, and no one may even notice him at all, because he will make no sound.

The price paid in slightly longer anoxic time seems repaid by the rescuers ability to protect the airway and mobilize assistance.

 

[pwl]

I have been reading my rescue book waiting for it to get a little warmer for class, and had a question on the ascent, I know I have to go up at a safe speed, but if there were people on the surface near enough to where the distressed diver would "pop" could I send him up "express"

can you be sure the patient will reach the surface in the right spot?

will people on the surface be looking for the patient?

will the people on the surface be able to reach the patient?

will the people on the surface realise the patient is unconscious?

I just finished EFR and seems that not breathing = no heartbeat ~= dead. no heartbeat / breathing then no Nitrogen exchange no reason to go up slow might as well pop the top.

i'd suggest that checking for pulse underwater is going to be extremely difficult, and the chance of getting a false negative (find no pulse when there actually is one) is quite high. i wouldn't want to rely on my ability to find a pulse in that situation.

also if there is any chance he can breath on his own at the surface faster is better. better to be alive in the deco chamber than dead. fully inflate his BC and let go? seems to make sense to me. tie a spool if you have one? not if there is significant current on surface or no one there then I would assume it is a recovery not a rescue. going up at a safe speed is for breathing divers.
no bubbles = no breathing / 4 sec assesment.

part of looking after yourself is ensuring you follow accepted protocols: sending a patient on a buoyant ascent may muddy the waters of responsibility, especially if it results in embolism or similar DCI.