Woman rescued near San Clemente Island - California

[TSandM]

This is an amazing and fabulous story. You should submit it to Alert Diver for publication. Only with the absolutely correct and insightful response from all involved was this lady going to survive. Your risk assessment on rapid surfacing was absolutely perfect and very rational. It was a delight to read, and you have saved a life.

 

[T.C.]

Excellent idea, TSandM. I second this.

 

[Power Scuba]

This is an amazing and fabulous story. You should submit it to Alert Diver for publication.

Alert Diver has indeed reached out to me and made the request for article.

Bill

 

[T.C.]

Alert Diver has indeed reached out to me and made the request for article.

Bill

I look forward to reading it.

 

[guyharrisonphoto]

All I can say is, when I finally realize my dream of diving SoCal, I am going to try to get on a powerscuba trip!

Amazingly done, folks!!

 

[Power Scuba]

All I can say is, when I finally realize my dream of diving SoCal, I am going to try to get on a powerscuba trip!

Amazingly done, folks!!

Thanks, guyharrisonphoto. You'd be very welcome. We have an amazing variety of divers in our 2,200-person org, are non-profit,... and the dues is really cheap (free).

If an article on this incident does get published, I'll be sure to note it here in this thread.

Bill

 

[drbill]

In addition to what has been viewed here regarding PowerScuba's approach to this incident, as a member I have followed Bill's post-incident actions for the group via e-mails and the web site. This is one of the most safety conscious recreational diving groups I'm aware of. Kudos.

 

[Storker]

In the case of this rescue, I absolutely agree that a rapid ascent was the way to go. And yes, it saved her life. However, other scenarios may differ due to the variables involved.

I don't know about you, but frankly, the prospect of getting somewhat bent probably wouldn't have been the first thing I was thinking of if I - God forbid - were to see an apparently lifeless diver sinking towards me.

As the saying goes: You can (often) fix bent, you can't fix dead.


(At least, I hope that's the way I'd react...)

--
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Typos are a feature, not a bug

 

[tracydr]

I'm happy to report the victim made a complete recovery after a 5 hour chamber ride, assorted tests (CT, Chest X-Ray, Neuro-exam, etc) and an overnight stay to be sure.

All details are not available yet, but I can state this:

1. Victim became unresponsive shortly after entering the water.
2. Crew noticed her descending without her buddy (who was still on deck kitting up) and put out a call for assistance. There were other divers on the surface and they were entreated to go down after her. At least one was able to do so.
3. There were also divers already underwater at approx 80fsw (bottom). Due to the excellent visibility, all four divers (two groups of two) saw the victim descending down through the water column head-first, "rag-doll-style". They witnessed her strike the bottom head-first. Three of the divers (all rescue-trained) made their way immediately to her while the fourth diver made his way to the surface to call for help.
4. The three divers brought the victim to the surface and called for help. They were approx 10 yards from the boat's swim step.
5. The victim was brought aboard, an assessment was performed (unresponsive, non-breathing, lips blue, and blood coming out of mouth), and CPR was immediately initiated. Boat captain initiated a call to the Coast Guard.
6. O2 was called for as well as the AED. I believe they were already being retrieved as the call went out for it.
7. After approx 2-3 minutes of CPR, rescuers detected faint breaths coming from victim. Breaths were determined to not be "death rattle" and breathing increased slightly in strength over the next couple of minutes. O2 was applied during this time as well.
8. AED pads applied for insurance. Victim was rolled onto her left side.
9. Victim began moaning.
10. Victim began crying out in pain.
11. A doctor was onboard and victim was turned over to her care.
12. Coast Guard notified boat captain that helicopter was on it's way from San Diego.
13. Victim was able to open eyes, nod her head in response to a question, and remained in a semi-responsive state for the duration.
14. Victim was picked up and transported to CG Station, San Diego and then transported to UCSD Hillcrest.
15. Victim was taken for a chamber ride and reported to have become extremely lucid once she was at depth.
16. Upon reaching port (about 5 1/2 hours later), her buddy and some passengers went to UCSD Hillcrest. She had just come out of a CT scan, was sitting up in her bed, was responsive, emotional... and could remember nothing of the day except "waking up" in the chamber.

She was released from UCSD Hillcrest Sunday afternoon.

I know many of you will have additional questions, but I won't have much more for you. Causality will be investigated to be sure, but unless she regains any memory of the incident, we may never know exactly why this happened. I have my suspicions, but I'll keep those to myself.

We read so many of these incidents wherein the victim did not survive. I'm so happy to share with you all this one had a happy ending.

Was she a drysuit diver? Makes me wonder if her neck seal was too tight.

---------- Post added April 14th, 2014 at 08:46 AM ----------

I appreciate everyone's comments regarding this incident.

One point of clarification: Witness statements, though collected afterward, did not accompany the victim onto the chopper. What DID accompany her was the timeline. A rescue-trained passenger saw that many other people were scrambling to attend to the essentials (CPR, assembling O2 kit, getting the AED, etc) and began writing down a timeline of what was done beginning with the victim being brought aboard the boat. This person wrote down what he was observing, important info I passed to him during and after CPR, and as much of the victim's info as we could gather up. This timeline and info sheet(s) was sealed in a freezer bag and passed to the Coast Guard rescuer, along with the victim's dive computer and overnight bag.

Most (if not all) of the witness statements were collected by the boat captain and used in his interview with the Coast Guard some days later.



Bill Powers

Scribing the incident is one important job that often gets missed in a rescue. When treating a "code" as a physician, one of my first tasks is to assign somebody to write everything down and use a watch to put times on everything.
great job!
I wonder if the blood/foam escaping could have been from a mild lung over expansion? Even not breathing victims will still have a residual volume of air that can over expand, since that aren't exhaling on the ascent.
As for the unconsciousness, I have a few ideas. Seizure, neck seal too tight causing a vagal episode ( decreased blood pressure), and an arrythmia, which could have corrected itself quickly so that it wouldn't be seen on EKG.
i don't think pulmonary edema would show up in such a short time frame after getting in the water, but there have been episodes of swimmers on the surface of the water getting pulmonary edema, so I guess that could cause loss of consciousness, too.

---------- Post added April 14th, 2014 at 08:52 AM ----------

The only thing that did not make sense to me was the chamber ride...in that DCS would have been highly UNLIKELY....

On the other hand, if the idea was to assist brain function after drowning with hyperbaric O2....this would make some sense given the response they mention of her becoming lucid at the bottom depth.....

What do you guys make of this?

Is it also possible that they were attempting to treating possible air embolism? My one concern with a chamber ride is that if somebody had a stroke, which may or may not show up early on CT, increased oxygen to the brain can cause lots of free radicals, which might, in theory damage injured brain tissue. I've seen a few strokes that only showed on MRI until a day or more later.

---------- Post added April 14th, 2014 at 08:57 AM ----------

I think he meant that you have to consciously take certain factors into consideration and make a judgement call. TGIF858 made a judgement call based upon time at depth, Nitrox mix, and the immediacy of the situation. Those of us on the boat were all told to keep an eye on the rescuers for any signs of DCS.

I think Matt's words of warning were meant to say "just because you've heard of some divers ascending 80 feet in 30 seconds without problems doesn't mean it's always a good idea in every emergency." Take ALL of the factors into consideration. Make the judgement call but realize that you're willfully taking a risk for the greater good, then do something to manage that risk (such as having people keep an eye out for symptoms).

In the case of this rescue, I absolutely agree that a rapid ascent was the way to go. And yes, it saved her life. However, other scenarios may differ due to the variables involved.


-Eric

My husband did a similar rescue of a student with cardiac arrest from 50-60 feet. They did stick him in the chamber just as a precaution.

 

[Greenjuice]

I wonder if the blood/foam escaping could have been from a mild lung over expansion?

Interested to hear your thoughts on this. To me, this was the hardest part of the story to fit with a discharge home the following day.

As for the unconsciousness, I have a few ideas. Seizure, neck seal too tight causing a vagal episode ( decreased blood pressure), and an arrythmia, ... pulmonary edema ... cause loss of consciousness, too.

These do seem most likely. There may be some other outside possibilities like hypoglycaemia and brainstem TIA.

a stroke, which may or may not show up early on CT, .... I've seen a few strokes that only showed on MRI until a day or more later.

Really early or late, MR definitely the better test, if you can get one. Diffusion MR shown to go positive (in animal studies) within minutes of ictus. CT change can take hours or days, but is much quicker, more practical and gives an answer most times. I suspect all tests were negative or they would have kept her in.



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