Rescue Breathing on the surface

[Knavey]

Working on my Rescue Diver certification right now and we were doing the resuce breathing drills in the pool.

I am wondering if there are any statistics out there that show divers surviving due to being given rescue breaths on the surface.

The technique is very awkward at best, and between the breaths the possibility of water entering the mouth/nose area is pretty good also.


Just wondering if anything substantiates rescue breathing or if the best course of action is get them aboard the boat or to the beach ASAP.

Thanks,

[ItsBruce]

I've seen discussions about rescue breaths being abandoned in favor of the speed of getting a victim aboard the boat or onto the beach, but until it becomes official, the official word is to stick to the program.

[spectrum]

Never seen statistics and of course the effectiveness will be a product of training and conditions. I doubt that anyone was ever saved by not being given rescue breaths though no doubt some victims will take on water.

I see your logic that if the boat (or shore) is nearby and the seas are aggressive then getting them out of the water expediently make sense. Unfortunately the clock keeps ticking on brain and other damage.

As you should be learning in your class it's all about doing the best you can with the situation you are dealt. Remember also that to remain legally secure you should be performing to the best of your training.

Pete

[crosing]

If the person's heart is not beating, no oxygen will be circulated so rescue breaths would be a waste of time in the water.

[JAMIE MCG]

During our Rescue class a point was brought up. Instead of giving breathes why could you not hold the reg in thier mouth and purge it ?

[2ndjetty]

I'm not an expert, but I think you could put air into their lungs more efficiently with rescue breathing. It will also be easier to tell if the air is getting into the chest or not

[DeepSeaDan]

During our Rescue class a point was brought up. Instead of giving breathes why could you not hold the reg in thier mouth and purge it ?

...why you cannot ventillate with a regulator:

1. You might overpressurize the lungs to the point of alveolar rupture & induce pneumothorax, embolism or other overinflation trauma

2. You cannot gauge "compliance" which is the ease ( or lack thereof ) of ventillatory inflation, thereby being unable to gauge how forcefully to ventillate.

DSD

[DeepSeaDan]

Working on my Rescue Diver certification right now and we were doing the resuce breathing drills in the pool.

I am wondering if there are any statistics out there that show divers surviving due to being given rescue breaths on the surface.

The technique is very awkward at best, and between the breaths the possibility of water entering the mouth/nose area is pretty good also.


Just wondering if anything substantiates rescue breathing or if the best course of action is get them aboard the boat or to the beach ASAP.

Thanks,


...on here a short while ago ( the thread was lost along with everything else back to May, I believe ).

Don't know if I have the energy to tackle it again! What do you say Kris B., shall we go for round two, or is it 200?! :D

DSD

[shark_tamer]

Haven't I read somewhere lately that the NEW procedure for reanimation is not 12 chest compressions and then 1 breath , but 20 compressions and then 1 breath because the most important is to have the blood circulated to the brain, not air in the lungs ?

*** Did not have to use the new technique yet, but it should be a work out for the responder !! :confused: :confused:

[Wildcard]

The new standard is 30:2 for one rescuer CPR
Using the purge valve will only fill the epigastrium (stomach) with air, dont do it.
Rescue breathing in the water in almost every situation is a waste of time, get them out where you can do some good.
Just my 20 something years of paramedicine to back up my opinion.

[DeepSeaDan]

Rescue breathing in the water in almost every situation is a waste of time, get them out where you can do some good.

Methinks you'll be seeing some significant changes to in-water resucitation protocols in the not-too-distant-future; no inside knowledge, just a hunch.

Watch for it.

DSD

[fisherdvm]

If the person's heart is not beating, no oxygen will be circulated so rescue breaths would be a waste of time in the water.

In the water, checking the pulse is difficult. The assumption is that they do have a pulse. Therefore, if you don't provide rescue breath - you would GUARANTEE that they don't have a pulse by the time you can get them on a hard surface.

The assumption for drown victim is similar to that of an unconscious child - rescue breath with the hope of reviving them - so they would spontanously breath on their own.

Your argument would make sense, if you are sure the victim has no heart beat, or had a heart attack (where study noted that rescue breath actually DECREASED the effectiveness of resuscitation). But for a drown victim or a small child - rescue breath is still the way to go.

[fisherdvm]

Rescue breathing in the water in almost every situation is a waste of time, get them out where you can do some good.
Just my 20 something years of paramedicine to back up my opinion.


Unless it is a very prompt in water rescue of a witnessed drowning, and the assumption is that they still have a heart beat. If you can get them to breath on their own promptly after the rescue, you might have saved them from being a mentally impaired invalid.

I would agree with your comment, only if it has been more than 3 minutes from the time of the witnessed drowning occurred. But if it is a witnessed drowning, and the victim is pulled immediately from the water..... I'd pray that the rescuer does not wait till they reach the boat before starting rescue breath....

One minute of lack of oxygen vs. 5 minutes?? I sure hope that you would start rescue breathing on me before my brain is irreversibly damaged.

That is a fine point in the rescue program that is hard to grasp: the timing of the trip to the boat or shore. As I understand, if you haven't revived them in 3 minutes of in water rescue breath, forget about it and drag them to shore immediately.

[Sideband]

During our Rescue class a point was brought up. Instead of giving breathes why could you not hold the reg in thier mouth and purge it ?

For the same reason your lungs do not inflate if you purge the reg while in your mouth. The purge valve. If you were to block the purge valve there would be a serious risk of lung over-expansion.

[Wildcard]

Unless it is a very prompt in water rescue of a witnessed drowning, and the assumption is that they still have a heart beat. If you can get them to breath on their own promptly after the rescue, you might have saved them from being a mentally impaired invalid.

I would agree with your comment, only if it has been more than 3 minutes from the time of the witnessed drowning occurred. But if it is a witnessed drowning, and the victim is pulled immediately from the water..... I'd pray that the rescuer does not wait till they reach the boat before starting rescue breath....

One minute of lack of oxygen vs. 5 minutes?? I sure hope that you would start rescue breathing on me before my brain is irreversibly damaged.

That is a fine point in the rescue program that is hard to grasp: the timing of the trip to the boat or shore. As I understand, if you haven't revived them in 3 minutes of in water rescue breath, forget about it and drag them to shore immediately.
This has been argued to death, no pun intended, before. It is hard if not near impossable for a profesional rescuer to provided a real patent airway and provided M2M on land, for a lay person, in the water it's almost pointless. IF! you are more than a few minutes from boat/land/safety AND you watched them go under, THEN it is worth trying once or twice. If the heart is still beating, then )2 is still circulating, granted at lower percentages but some non the less is still there....I have run well over 500 codes and prolly 40-50 of them have been drownings including one nightmarish week in Sacramento when I ran 4, 2 in one day. I know of which I speak.
Kind of a strange twist on one of those. Woman walking into the river to kill herself, and she does, witnessed by Sacto PD. DART team pullerd her out after 30 minutes apnic and pulseless. Monitor shows asystole. My partner starts compressions. He got two done and I stoped him, she had regained NSR with a plapable pulse:11: She never resumed breathing on her own and was unpluged, brain dead the next day.

[Wildcard]

For the same reason your lungs do not inflate if you purge the reg while in your mouth. The purge valve. If you were to block the purge valve there would be a serious risk of lung over-expansion.
Your epiglotis closes preventing overpressure. Has nothing to do with an uncons person. It's easer to inflate the stomach than the lungs unless the airway is patent. THEN lung OP injuries could result. Basicly it wont work unless you know exactly what your doing. Demnad valves were pulled from most hospitals and ambulances many years ago due to too many user errors. DONT DO IT!

[northen diver]

If the person's heart is not beating, no oxygen will be circulated so rescue breaths would be a waste of time in the water.


Uh Oh!........Someone had better tell the ALA (American Lifegaurding Association) and the USLA (United States Lifesaving Association), The ARC (American Red Cross), the YMCA's and the various agencies teaching rescue diving classes because ALL of these agencies are teaching this skill. I am no doctor, so I go with my training that I am taught. Is rescue breathing hard in the water while towing a victim? Sure it is. Get trained and practice it often and it'll get easier. Remember, only 14 percent of victims receiving CPR survives. Am I going to use this low percentage as a reason to not to do CPR.

[Trwmodela]

A few Rescue breaths can only help a patient as it is hard to determine a heart beat in the water. But towing the diver to get them out of the water should take place at the same time. Do a few Rescue breaths then get moving towards the boat or land. If you have an AED on the boat or close by that is going to be very important. I do carry a rescue pocket mask in my BCD. Suggestiion do what you are taught in the class but keep asking good questions.

Glad you are taking the Rescue Course as I learned a lot.

[crosing]

Uh Oh!........Someone had better tell the ALA (American Lifegaurding Association) and the USLA (United States Lifesaving Association), The ARC (American Red Cross), the YMCA's and the various agencies teaching rescue diving classes because ALL of these agencies are teaching this skill. I am no doctor, so I go with my training that I am taught. Is rescue breathing hard in the water while towing a victim? Sure it is. Get trained and practice it often and it'll get easier. Remember, only 14 percent of victims receiving CPR survives. Am I going to use this low percentage as a reason to not to do CPR.

You should read my post again. I said nothing about CPR. My point was that if the person's heart is not beating doing rescue breaths in the water is a waste of time as no oxygen would be circulating. You should get the person to shore as fast as possible where you can actually do CPR.

As people have pointed out it is quite difficult to determine if a person's heart is beating in the water so it is probably better to do some rescue breaths in the water.

The issue I have with doing rescue breaths in the water is: unless you are well trained on it and practice alot, it is difficult and time consuming process that may or may not have any beneficial effect. If you waste alot of time doing rescue breaths in the water and the heart is not beating you've wasted precious time that could have been used doing CPR on land or boat.

Also as someone else stated, the CPR guidelines have changed or are about to change to increase the compressions to reflect that it is more important to circulate the blood which delivers the oxygen to the brain and other organs.

[skresch]

Haven't I read somewhere lately that the NEW procedure for reanimation is not 12 chest compressions and then 1 breath , but 20 compressions and then 1 breath because the most important is to have the blood circulated to the brain, not air in the lungs ?

*** Did not have to use the new technique yet, but it should be a work out for the responder !! :confused: :confused:

Single responder: 20 compressions to 1 breath
Multi responder: 5 compressions to 1 breath

[northen diver]

You should read my post again. I said nothing about CPR. My point was that if the person's heart is not beating doing rescue breaths in the water is a waste of time as no oxygen would be circulating. You should get the person to shore as fast as possible where you can actually do CPR.

As people have pointed out it is quite difficult to determine if a person's heart is beating in the water so it is probably better to do some rescue breaths in the water.

The issue I have with doing rescue breaths in the water is: unless you are well trained on it and practice alot, it is difficult and time consuming process that may or may not have any beneficial effect. If you waste alot of time doing rescue breaths in the water and the heart is not beating you've wasted precious time that could have been used doing CPR on land or boat.

Also as someone else stated, the CPR guidelines have changed or are about to change to increase the compressions to reflect that it is more important to circulate the blood which delivers the oxygen to the brain and other organs.


Perhaps I confused you when I mentioned CPR. The ALA, USLA, YMCA, ARC all teaches deep water rescue breathing on thier rescue training courses. That is why I had put your statement that doing rescue breathing in the water is a waste of time, in bold letters. My point is that all of these agencies teaches this rescue method for a reason. Because it works! Now at what percentage. Who knows. BUT, keep in mind that CPR on land only has a survival rate of 14 percent for BLS.

[donooo]

Uh Oh!........Someone had better tell the ALA (American Lifegaurding Association) and the USLA (United States Lifesaving Association), The ARC (American Red Cross), the YMCA's and the various agencies teaching rescue diving classes because ALL of these agencies are teaching this skill. I am no doctor, so I go with my training that I am taught. Is rescue breathing hard in the water while towing a victim? Sure it is. Get trained and practice it often and it'll get easier. Remember, only 14 percent of victims receiving CPR survives. Am I going to use this low percentage as a reason to not to do CPR.
I am both an ARC Instructor and a DAN Instructor, but not a Lifeguard Instructor. I teach the ARC CPR for the Professional Rescuer class that is part of the Lifeguarding Program. In the CPR class there is no discussion of in water Rescue Breathing.
In the ARC Lay responder course and most all dive organization CPR classes, ( EFR and Medic First Aid ) you are taught Lay Responder CPR. That is two breaths and then 30 chest compressions. You are not taught to do rescue breathing alone or to check a pulse.
In the ARC CPR/Pro class or the DAN BLSpro class you are taught to check for a pulse and to do rescue breathing alone. No discussion of in water ventillations.

So what we have is a hole between the old training and the new training that the RSTC has not responded to and some instructors are trying to fill in. If your CPR training tells you that you are not qualified to do rescue breathing alone and your dive Instructor teaches you how to do it then ?????

But, by the way, there is no requirement for your Instructor to be current in CPR anyway. Best bet is to take the higher level of CPR so that you can perform rescue breathing if need be, but drag the victim as fast as you can to shore or a boat and get help.

It has been rumored that RSTC is re evaluating the unconscious diver excersis for both Rescue classes and DM/DCS classes, but until the do,,, there is a hole.

adios don O

[northen diver]

Single responder: 20 compressions to 1 breath
Multi responder: 5 compressions to 1 breath



Wrong! Your profile says your interest is medicine and flying. I really hope your not a flight medic.....

30:2 for a single responder AND for a 2 person team.

This is why the compressions changed recently

One study of 176 adults receiving CPR in European cities found that paramedics and nurse anesthetists performed chest compressions “only half of the available time,” reported Lars Wik, MD, PhD, of Ulleval University Hospital in Oslo, Norway, and colleagues. In another study, Lance B. Becker, MD, of University of Chicago Hospitals in Illinois, and colleagues reported that well-trained hospital staff performed inconsistent CPR that frequently did not meet published CPR guideline recommendations.

[freediver]

The issue I have with doing rescue breaths in the water is: unless you are well trained on it and practice alot, it is difficult and time consuming process that may or may not have any beneficial effect. If you waste alot of time doing rescue breaths in the water and the heart is not beating you've wasted precious time that could have been used doing CPR on land or boat.
Maybe this IS the issue. I am of the opinion that you SHOULD be well trained in it and practice it alot. If there is any reason to think that the person has a condition that might be corrected in water (respiratory arrest) then rescue breaths could be very beneficial. Why let a potentially correctable condition (respiratory arrest) lead to a very grim condition (cardiac arrest) without the attempt? My qualifying conditions would be a victim of blackout and a limited term immersion.
By the way, to an earlier post, the American Red Cross no longer teaches in-water resuscitation.

[northen diver]

I am both an ARC Instructor and a DAN Instructor, but not a Lifeguard Instructor. I teach the ARC CPR for the Professional Rescuer class that is part of the Lifeguarding Program. In the CPR class there is no discussion of in water Rescue Breathing.
In the ARC Lay responder course and most all dive organization CPR classes, ( EFR and Medic First Aid ) you are taught Lay Responder CPR. That is two breaths and then 30 chest compressions. You are not taught to do rescue breathing alone or to check a pulse.
In the ARC CPR/Pro class or the DAN BLSpro class you are taught to check for a pulse and to do rescue breathing alone. No discussion of in water ventillations.

So what we have is a hole between the old training and the new training that the RSTC has not responded to and some instructors are trying to fill in. If your CPR training tells you that you are not qualified to do rescue breathing alone and your dive Instructor teaches you how to do it then ?????

But, by the way, there is no requirement for your Instructor to be current in CPR anyway. Best bet is to take the higher level of CPR so that you can perform rescue breathing if need be, but drag the victim as fast as you can to shore or a boat and get help.

It has been rumored that RSTC is re evaluating the unconscious diver excersis for both Rescue classes and DM/DCS classes, but until the do,,, there is a hole.

adios don O

First off, you had better go back to your local ARC chapter and get updated on your CPR PR AND instructor lifegaurding. It changed six months ago. ARC IS teaching the deep water rescue breathing NOW. YMCA ALS and USLA alway has for years. The ARC was a little behind. The ARC lifeguard also NOW has to be taught O2 admin. also in the new requirements. Go to www. ARC, click on instructor training (your local chapter will give you a password if your an instructor) and you'll see all of the requirements. Also, the instructors dont need to keep taking CPR classes over and over just to teach it. As long as you teach twice a year, your instructor card is good.


PLEASE STOP advocating that rescue breathing is a waste of time. You ARE NOT a doctor are you? All of these agencies are teaching this skill for a reason. Stick to your training. If you disagree with it, so be it, but dont spout off like you KNOW its a waste of time unless you have some real proof.

[northen diver]

I am both an ARC Instructor and a DAN Instructor, but not a Lifeguard Instructor. I teach the ARC CPR for the Professional Rescuer class that is part of the Lifeguarding Program. In the CPR class there is no discussion of in water Rescue Breathing.
In the ARC Lay responder course and most all dive organization CPR classes, ( EFR and Medic First Aid ) you are taught Lay Responder CPR. That is two breaths and then 30 chest compressions. You are not taught to do rescue breathing alone or to check a pulse.
In the ARC CPR/Pro class or the DAN BLSpro class you are taught to check for a pulse and to do rescue breathing alone. No discussion of in water ventillations.

So what we have is a hole between the old training and the new training that the RSTC has not responded to and some instructors are trying to fill in. If your CPR training tells you that you are not qualified to do rescue breathing alone and your dive Instructor teaches you how to do it then ?????

But, by the way, there is no requirement for your Instructor to be current in CPR anyway. Best bet is to take the higher level of CPR so that you can perform rescue breathing if need be, but drag the victim as fast as you can to shore or a boat and get help.

It has been rumored that RSTC is re evaluating the unconscious diver excersis for both Rescue classes and DM/DCS classes, but until the do,,, there is a hole.

adios don O

Also, if you are teaching only the CPR-PR portion, the lifegaurd instructor will be teaching the rescue breathing portion of the training since it is a water skill, not the CPR-PR instructor, and another person would teach the O2 admin if the LGI or CPR instructor isnt qualified to teach O2 admin.

[ffhamm]

Current American Heart protocol (Most agencies follow current American Heart Standards) is 30:2 for everyone except infants.

Rescue breathing without chest compressions is no longer taught to laypersons.

Provider training states that "Healthcare providers will be taught to deliver rescue breaths without chest compressions for the victim with respiratory arrest and a perfusing rhythm (ie, pulses). Rescue breaths without chest compressions should be delivered at a rate of about 10 to 12 breaths per minute for the adult "

Your rescue diver class probably advocates "rescue breathing" during a suface tow. My *OPINION* is that this *MAY* be a good idea for an extended tow. But on a short surface tow it may be a waste of time. The problem being, that your time to shore/boat will be signifigantly longer (if youve never tried to deliver breaths while towing, give it a go sometime) a patent airway is hard to maintain and a pulsless pt needs chest compressions. Weak/rapid pulses are sometimes hard to find, even on a pt that is laying in a hospital bed. If you know your patient has pulses, you would be helping by giving rescue breaths.

I would do whatever you're taught by whatever agency instructed you. You know you are providing the highest level of care that you are able. I know what I would do.

Not to muddy the water even more, but there are signifigant changes that are driven by several studies that will most likely change cpr soon.


Jeff

[donooo]

First off, you had better go back to your local ARC chapter and get updated on your CPR PR AND instructor lifegaurding. It changed six months ago. ARC IS teaching the deep water rescue breathing NOW. YMCA ALS and USLA alway has for years. The ARC was a little behind. The ARC lifeguard also NOW has to be taught O2 admin. also in the new requirements. Go to www. ARC, click on instructor training (your local chapter will give you a password if your an instructor) and you'll see all of the requirements. Also, the instructors dont need to keep taking CPR classes over and over just to teach it. As long as you teach twice a year, your instructor card is good.


PLEASE STOP advocating that rescue breathing is a waste of time. You ARE NOT a doctor are you? All of these agencies are teaching this skill for a reason. Stick to your training. If you disagree with it, so be it, but dont spout off like you KNOW its a waste of time unless you have some real proof.

Go back and read. 1) I said I am not a Life guard Instructor and as you pointed out in your next post, the Lifeguard Instructor teaches in water ventillations. (maybe) 2) Dive Instructors are not automatically re newed in CPR when not teaching CPR classes like Medic First Aid or EFR. An instructor does not get a new CPR cert for teaching Rescue Diver or a DM class. There is no requirement for an instructor or DM/Dive Con to be current 3) Nobody says Rescue Breathing is a waste of time? I said be trained to do it if need be. Take an Advanced class. Each case will be different. If I am 50 feet from a boat messing around with gear and breathing is a wast of time. And by the way, if you have a Lay responder card that says you are not qualified to do rescue breathing only and you screw around "trying" what are the consequences?

don O

[markr]

Wrong! Your profile says your interest is medicine and flying. I really hope your not a flight medic.....

30:2 for a single responder AND for a 2 person team.

This is why the compressions changed recently

One study of 176 adults receiving CPR in European cities found that paramedics and nurse anesthetists performed chest compressions “only half of the available time,” reported Lars Wik, MD, PhD, of Ulleval University Hospital in Oslo, Norway, and colleagues. In another study, Lance B. Becker, MD, of University of Chicago Hospitals in Illinois, and colleagues reported that well-trained hospital staff performed inconsistent CPR that frequently did not meet published CPR guideline recommendations.

You are also wrong. The compression-ventilation ratio is not the same for one and two person rescues.

The following quote was copied from the American Heart Association's guidelines for CPR:
" A compression-ventilation ratio of 30:2 is recommended and further validation of this guideline is needed (Class IIa). In infants and children (see Part 11: "Pediatric Basic Life Support"), 2 rescuers should use a ratio of 15:2 (Class IIb)."

The following quote came from the same source and refers to CPR being provided by non-professionals:
"
Compression-Only CPR
The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest. In surveys healthcare providers as well as lay rescuers were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.
In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation (LOE 3; 4). Some animal studies (LOE 6) and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR for VF SCA. If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. In addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR. Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths (Class IIa), although the best method of CPR is compressions coordinated with ventilations."



Here's a link to the whole document:

http://circ.ahajournals.org/content/vol112/24_suppl/


The bits I copied are from part 4 Adult Basic Life Support.

[Paco II]

Ok, one last fix to this posting.

1. The article referred to is from 2005
2. The comment about 2 rescuers is referring to infants and children.
3. When doing CPR on an adult, it does not matter how many rescuers are involved, it is always 30:2. That is what I was taught in the course I took in May.



You are also wrong. The compression-ventilation ratio is not the same for one and two person rescues.

The following quote was copied from the American Heart Association's guidelines for CPR:
" A compression-ventilation ratio of 30:2 is recommended and further validation of this guideline is needed (Class IIa). In infants and children (see Part 11: "Pediatric Basic Life Support"), 2 rescuers should use a ratio of 15:2 (Class IIb)."

The following quote came from the same source and refers to CPR being provided by non-professionals:
"
Compression-Only CPR
The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest. In surveys healthcare providers as well as lay rescuers were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.
In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation (LOE 3; 4). Some animal studies (LOE 6) and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR for VF SCA. If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. In addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR. Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths (Class IIa), although the best method of CPR is compressions coordinated with ventilations."



Here's a link to the whole document:

http://circ.ahajournals.org/content/vol112/24_suppl/


The bits I copied are from part 4 Adult Basic Life Support.

[northen diver]

You are also wrong. The compression-ventilation ratio is not the same for one and two person rescues.

The following quote was copied from the American Heart Association's guidelines for CPR:
" A compression-ventilation ratio of 30:2 is recommended and further validation of this guideline is needed (Class IIa). In infants and children (see Part 11: "Pediatric Basic Life Support"), 2 rescuers should use a ratio of 15:2 (Class IIb)."

The following quote came from the same source and refers to CPR being provided by non-professionals:
"
Compression-Only CPR
The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest. In surveys healthcare providers as well as lay rescuers were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.
In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation (LOE 3; 4). Some animal studies (LOE 6) and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR for VF SCA. If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. In addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR. Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths (Class IIa), although the best method of CPR is compressions coordinated with ventilations."



Here's a link to the whole document:

http://circ.ahajournals.org/content/vol112/24_suppl/


The bits I copied are from part 4 Adult Basic Life Support.


You have some old materail. I didnt mention infants due to we were talking about a SCUBA rescue class and I havent seen an infant diving as of yet;)




BLS Healthcare Provider


2006 Study Guide


Source: HCP AHA Text and St David Healthcare Partnership









Basic Life Support for





Healthcare Providers





Many of the changes in BLS recommended

in 2005 are designed to simplify CPR
recommendations (including eliminating
differences in technique for different ages
when possible), increase the number and
quality of chest compressions delivered,
and increase the number of uninterrupted
chest compressions.
A universal compression-to-ventilation ratio
of 30 to 2 is recommended for lone rescuers
for victims of all ages (except newborns).
This 30:2 compression-to-ventilation
ratio also applies to healthcare providers

performing 2-rescuer CPR for




adult victims






until an advanced airway (eg, endotracheal


tube, esophageal-tracheal combitube


[Combitube], or laryngeal mask airway

[LMA]) is in place. Once an advanced

airway is in place, 2 rescuers should no
longer provide cycles of CPR with pauses
in compressions to give rescue breaths

[northen diver]

Go back and read. 1) I said I am not a Life guard Instructor and as you pointed out in your next post, the Lifeguard Instructor teaches in water ventillations. (maybe) 2) Dive Instructors are not automatically re newed in CPR when not teaching CPR classes like Medic First Aid or EFR. An instructor does not get a new CPR cert for teaching Rescue Diver or a DM class. There is no requirement for an instructor or DM/Dive Con to be current 3) Nobody says Rescue Breathing is a waste of time? I said be trained to do it if need be. Take an Advanced class. Each case will be different. If I am 50 feet from a boat messing around with gear and breathing is a wast of time. And by the way, if you have a Lay responder card that says you are not qualified to do rescue breathing only and you screw around "trying" what are the consequences?

don O



Didnt someone say:
If the person's heart is not beating, no oxygen will be circulated so rescue breaths would be a waste of time in the water.

[ffhamm]

You have some old materail. [


in 2005 are designed to simplify CPR
recommendations (including eliminating

A universal compression-to-ventilation ratio
of 30 to 2 is recommended for lone rescuers
for victims of all ages (except newborns).
This 30:2 compression-to-ventilation
[
until an advanced airway (eg, endotracheal

tube, esophageal-tracheal combitube
[LEFT][Combitube], or laryngeal mask airway
[LMA]) is in place. Once an advanced
airway is in place, 2 rescuers should no
longer provide cycles of CPR with pauses
in compressions to give rescue breaths


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2005 AHA standards are the latest at this time. AHA guidelines are based on science and studies of pt outcomes. After a guideline is released, it takes a while to track trends and make appropriate changes.

Remember: Most people that have questions about this are "layperson' level certified. Layperson cpr does not include rescue breaths *only* anymore.

The reason rescue breaths are still recommended in rescue diver classes, is we assume the patient is apnic due to asphyxiation and there is the possibility that they still have a pulse. Remember also, there are potential causes that are NOT drowning. Use you training and do what you were taught. You will provide the highest level of care you are capable of.

No reason to make CPR harder than it has to be. 30 (hard and fast, 100 per minute):2 (slow breaths that cause rise of chest) is good. Follow AHA (or whoever taught your class) guidelines after the pt is removed from the water. A layperson will not be intubating a pt, so we probably don't need to be discusssing continuous compressions.

Jeff (AHA instructor)

[donooo]

Also, the instructors dont need to keep taking CPR classes over and over just to teach it. As long as you teach twice a year, your instructor card is good.

That is not the way it is with the ARC. Just being an Instructor does not meet your requirements for being certified. If you need certification you must TAKE a class. Now what you are saying may be true for EFR or Medic First Aid but I have chosen to not go that way. I am sure that being a DAN BLSpro instructor does not meet a CPR requirement. In fact being both a DM and a DiveConn I have no requirements to be current. I feel that all dive professionals should be trained and current at the Pro level, maybe even the students in the Rescue classes.

In water ventilations is not a waste of time. I never said it was. It is a tool and may be necessary. Proper training is necessary.

You people that keep bringing up chest compression only need to read the first line / paragraph of every article again. It is "better then nothing" and "if the responder will not provide rescue breaths" is common to all of those articles.

don O

[freediver]

If I could please clarify on some misinformation.
1) The American Red Cross DOES NOT teach in-water rescue breathing in the lifeguard program and has not since 1994.
2) In reference to the O2 admin statement.... this is not a required portion of the lifeguard training course; it remains an optional component.
3) The American Red Cross instructor that teaches at least one class per year is reauthorized for a two-year calendar period, however, they do not receive a basic level participation card for this teaching. An instructor, in order to maintain CPR certification, must take the appropriate level CPR class just like everyone else.
4) Although extremely limited, research has shown that in-water resuscitation is effective in improving outcome of drowning victims.

[bubba105]

From someone who has done CPR, probably, 500 times in my 25 years with the FDNY, the people banging heads on this thread are the people I want around if I fail in the water. These are the people who are going to DO SOMETHING. Who cares what one agency or another says. Is rescue breathing in the water going to help? Probaly not, but, who cares, it couldn't hurt, do something. Tell you the truth, if I found no heart beat on initial examination, I would probably include a cardiac thump. Will it help, who knows, the alternative is death. Heart beats don't just magically come back, CPR/rescue breathing is the time to pull out all the stops. BTW, 500 tries, 2 saves, but, 2 beats none.

http://www.redcross.org/article/0,1072,0_332_4975,00.html

[northen diver]

If I could please clarify on some misinformation.
1) The American Red Cross DOES NOT teach in-water rescue breathing in the lifeguard program and has not since 1994.
2) In reference to the O2 admin statement.... this is not a required portion of the lifeguard training course; it remains an optional component.
3) The American Red Cross instructor that teaches at least one class per year is reauthorized for a two-year calendar period, however, they do not receive a basic level participation card for this teaching. An instructor, in order to maintain CPR certification, must take the appropriate level CPR class just like everyone else.
4) Although extremely limited, research has shown that in-water resuscitation is effective in improving outcome of drowning victims.


**SIGN** while banging my head on the table.......
1. ARC does teach deep water rescue breathing. NOT in the poolside training, in the waterfront portion. They also teach mask and fins usage and water line searches. Its all in section 10 of the NEW instructor manual for waterfront training. Also in Lesson 5 in the RESCUE BREATHING part of the poolside training. It used to be a cross over training for all YMCA employeed lifeguards that were trained by the ARC because the Y's had that in thier training and had the O2 bottles on thier decks. As of this year its MANDATORY for the ARC lifegaurding classes.
2. O2 was optional in the poolside training, but now its mandatory as of end of this year.
3. Used to teach one class a year, its now two classes a year for the NON-Lay responder.

4. I agree. Even if its only a small percentage.

[northen diver]

2005 AHA standards are the latest at this time. AHA guidelines are based on science and studies of pt outcomes. After a guideline is released, it takes a while to track trends and make appropriate changes.

Remember: Most people that have questions about this are "layperson' level certified. Layperson cpr does not include rescue breaths *only* anymore.

The reason rescue breaths are still recommended in rescue diver classes, is we assume the patient is apnic due to asphyxiation and there is the possibility that they still have a pulse. Remember also, there are potential causes that are NOT drowning. Use you training and do what you were taught. You will provide the highest level of care you are capable of.

No reason to make CPR harder than it has to be. 30 (hard and fast, 100 per minute):2 (slow breaths that cause rise of chest) is good. Follow AHA (or whoever taught your class) guidelines after the pt is removed from the water. A layperson will not be intubating a pt, so we probably don't need to be discusssing continuous compressions.

Jeff (AHA instructor)

Jeff- The AHA changed thier compression ratio's sometime in 2005. I am not sure what month it was. I had seen a report posted dated 2005 with different ratio from what is being taught now by the AHA and I had thought that maybe it was an older recommended ratio. Your last name isnt by chance Brosius?

[Tom Winters]

CPR is tough enough to do on dry, flat land. Fuggedaboudit in the water. If it's a requirement for your rescue or dm class, just do it. If you have to deal with it real-life, get the victim on shore or on a boat as quickly, and safely, as you can. Then take it from there.

[freediver]

**SIGN** while banging my head on the table.......
1. ARC does teach deep water rescue breathing. NOT in the poolside training, in the waterfront portion. They also teach mask and fins usage and water line searches. Its all in section 10 of the NEW instructor manual for waterfront training. Also in Lesson 5 in the RESCUE BREATHING part of the poolside training. It used to be a cross over training for all YMCA employeed lifeguards that were trained by the ARC because the Y's had that in thier training and had the O2 bottles on thier decks. As of this year its MANDATORY for the ARC lifegaurding classes.
2. O2 was optional in the poolside training, but now its mandatory as of end of this year.
3. Used to teach one class a year, its now two classes a year for the NON-Lay responder.

4. I agree. Even if its only a small percentage.
northen diver, I must ask, are you an American Red Cross authorized lifeguard instructor? Could you share your source of information? While mask and fins usage along with deep and shallow water line searches are taught, in-water rescue breathing is not. It is not in pool lifeguard training, waterfront nor waterpark training.
AED is a required component in lifeguard training, O2 admin is not.
Also, per ARC instructor manual, "To be reauthorized as a Lifeguarding instructor, you must teach or co-teach at least one of the following within the authorization period:
1) Lifeguarding (including CPR/AED for the PR)
2)Shallow water attendant (including CPR/AED for the PR).
Again, I would love to know your source.

[donooo]

I do most of my CPR/Pro classes in Tucson. They train a lot of lifeguards. O2 is never taught. The pools have no O2. I can teach it, they don't want it. You think next year that the city of Tucson is suddenly going to pay for O2 training when they have none.

They only teach for the pools, now you are talking waterfront. Basic lifeguarding does not include in water ventilations or O2.

I am with freediver, I'll just wait for the sources, maybe some references.

don O

[scjoe]

Regardless of what is taught or by whom, it is not practical for the average weekend recreational diver to both tow a diver and continue rescue breathing for any extended period of time. The tow will go very slowly and the average rescue diver will wear themselves out before they reach the shore. Now you have two divers in trouble. If you can stay put and call a boat or other divers over for help that is a different situation.

[northen diver]

I do most of my CPR/Pro classes in Tucson. They train a lot of lifeguards. O2 is never taught. The pools have no O2. I can teach it, they don't want it. You think next year that the city of Tucson is suddenly going to pay for O2 training when they have none.

They only teach for the pools, now you are talking waterfront. Basic lifeguarding does not include in water ventilations or O2.

I am with freediver, I'll just wait for the sources, maybe some references.

don O


From the ARC website.

Lifeguarding instructors will be trained to teach the following basic-level courses:
· Lifeguard Training (includes first aid and CPR for the Professional Rescuer);
· AED Essentials;
· Oxygen Administration Training for the Professional Rescuer;
· Preventing Disease Transmission (Bloodborne Pathogens);
· Community Water Safety;
· Basic Water Rescue;
· Safety Training for Swim Coaches (must meet requirements as outlined in Connection #86, September 21, 1999); and
Lifeguard Management (After release in late Fall 2001, Lifeguarding instructors may complete a self-study or group orientation to the new materials and submit a verification form to their local chapter.

And then:

Lifeguarding instructors will be trained to teach the following basic-level courses:
· Lifeguard Training (includes first aid and CPR for the Professional Rescuer);
· AED Essentials;
· Oxygen Administration Training for the Professional Rescuer;
· Preventing Disease Transmission (Bloodborne Pathogens);
· Community Water Safety;
· Basic Water Rescue;
· Safety Training for Swim Coaches (must meet requirements as outlined in Connection #86, September 21, 1999); and
Lifeguard Management (After release in late Fall 2001, Lifeguarding instructors may complete a self-study or group orientation to the new materials and submit a verification form to their local chapter.



I dont have a book. I have a CD that I work from. I'll load the CD and copy and paste the rescue breathing when I get a chance.

I keep hearing from different ARC instructors that they were never told that there is a new course out. Contact your local ARC chapter and get the CD for the new course if you dont have it yet. You are also suppose to take a self admin. CBT and that is mailed in for a new instructor card.

[northen diver]

I do most of my CPR/Pro classes in Tucson. They train a lot of lifeguards. O2 is never taught. The pools have no O2. I can teach it, they don't want it. You think next year that the city of Tucson is suddenly going to pay for O2 training when they have none.

They only teach for the pools, now you are talking waterfront. Basic lifeguarding does not include in water ventilations or O2.

I am with freediver, I'll just wait for the sources, maybe some references.

don O

All of this is included in the lifeguarding training course monies. They dont have to pay anything extra. There are a LOT of pools that dont have back boards and AED's, yet the ARC, ALA, YMCA gaurds are all taught backboarding and AED use in thier training programs. The O2 admin, deep water rescue breathing and bloodborne pathalogy just wasnt taught at many of the ARC and MANY ARC gaurds are working at YMCA's and waterfront lakes and the ALA and YMCA programs had offered these for years and the ARC was behind them in thier training. So the ARC is updating the thier program to stay current with the rest of the certified agencies.

[northen diver]

Regardless of what is taught or by whom, it is not practical for the average weekend recreational diver to both tow a diver and continue rescue breathing for any extended period of time. The tow will go very slowly and the average rescue diver will wear themselves out before they reach the shore. Now you have two divers in trouble. If you can stay put and call a boat or other divers over for help that is a different situation.


Or stay put and call a boat or other divers over for help WHILE you are performing the rescue breaths?..Ever did CPR. Its difficult to perform CPR on land for an extended amount of time by yourself also. It is just very difficult, physically.

[donooo]

Northern Diver, 100%, that is what Lifeguard Instructors need to be able to teach. But O2 and Bloodborne Pathogens are options for Lifeguards, dependent on the needs and requirements of the community.

Find the printout of the Red Cross Hierarchy, it tells a lot.

https://www.instructorscorner.org/ViewDocument.aspx?DocumentId=2360

The CPR/Pro class does not need to include O2 and Lifeguard training does not need O2 or Bloodborne Pathogens.

don O

[northen diver]

Northern Diver, 100%, that is what Lifeguard Instructors need to be able to teach. But O2 and Bloodborne Pathogens are options for Lifeguards, dependent on the needs and requirements of the community.

Find the printout of the Red Cross Hierarchy, it tells a lot.

https://www.instructorscorner.org/ViewDocument.aspx?DocumentId=2360

The CPR/Pro class does not need to include O2 and Lifeguard training does not need O2 or Bloodborne Pathogens.

don O


In the students NEW books, it has O2, and blood pathogen sections in them (for the basic course, which is pool side training). ALL gaurds will be taught O2 admin and bbp. Why would it be in their books if it isnt to be taught. It isnt based on the need of the communities. Some Y's and waterfronts lakes dont and some do have O2, backboards, bbp kits and AED's that are operating in the same towns or communites. It's all taught as the BASIC lifeguarding class now. It used to be based off need for the if a gaurd asked for the O2 or bbp, it would be taught at an extra cost and an extra class. NOW it is All taught in the same cost and in the same class as part of the lifeguarding course.

[dlent]

Currently, the Red Cross is teaching 30 compressions to 2 breaths.


Single responder: 20 compressions to 1 breath
Multi responder: 5 compressions to 1 breath

[scjoe]

Northern Diver,

You cannot perform CPR in the water. You can give a rescue breath in the water.

[northen diver]

Northern Diver,

You cannot perform CPR in the water. You can give a rescue breath in the water.


I never said that you can perform CPR in the water?

[tracydr]

Haven't I read somewhere lately that the NEW procedure for reanimation is not 12 chest compressions and then 1 breath , but 20 compressions and then 1 breath because the most important is to have the blood circulated to the brain, not air in the lungs ?

*** Did not have to use the new technique yet, but it should be a work out for the responder !! :confused: :confused:

Keep in mind, most CPR research is done with cardiac arrest due to v-fib. You are also in a dry situation and able to check pulse. The difference in a drowning victim is substantial. There is a good chance that resp. arrest has not yet caused cardiac arrest. (although it will shortly) Therefore, a few rescue breaths in the water may very well get a non-breathing or weakly breathing victim back quickly.

[tracydr]

Regardless of what is taught or by whom, it is not practical for the average weekend recreational diver to both tow a diver and continue rescue breathing for any extended period of time. The tow will go very slowly and the average rescue diver will wear themselves out before they reach the shore. Now you have two divers in trouble. If you can stay put and call a boat or other divers over for help that is a different situation.

Just took rescue diver last month. Recommendation for rescue breathing is different if the tow is long or short. For a long tow you give two rescue breaths and then begin towing. For a shorter two you breath the entire time.
Don't have my book sitting right here so I'm not going to try to quote the actual length/time of the tows.
I would go by what is taught and try to keep up with current guidelines as well.
Just took my Advanced Cardiac Life support for about the 20th time. Used to be an instructor but went back to complete residency and wasn't able to teach for two years. Anyway, the 30:2 ratio is correct. Not doing rescue breaths is only for lay persons "if they are reluctant to do them due to possible disease transmission".
I consider rescue breathing very important (and far more effective if you use your mask/get a good seal) because a non-breathing or shallow breathing victim may still have a pulse. The physiology behind why they are down is so much different from a cardiac victim. (unless of course they had a heart attack in water, then all bets are off) I think of them more like a neonatal or pediatric patient because the primary problem is lack of oxygen rather then heart attack.
JMHO along with some valuable ER experience of my own.
By the way, you may actually use this stuff in real life so learn it well. I saved a toddler next door one time. He had been in the pool probably 10-15 minutes and was pulseless/not breathing and blue. When I arrived the BLS EMT guys were attempting to provide O2 with a non-rebreather and not providing chest compressions. I started proper CPR and got a bag/valve mask going to provide positive pressure breaths (instead of O2 flowing past his face doing him no good) and then intubated as quickly as possible.
Kiddo's temp was 86 degrees when he arrived to the nearest ER. (EMTs were going to take him into town, a 20 min drive when the army hospital was 5 min away!!!)
Parents brought the kid by my house a week later and he looked great. Talk about a gratifying experience. Much better than 99% of the codes I've run in the hospital with poor outcomes.
Point is, drowning victims stand a much better chance of survival then other types of arrests and positive pressure breathing can save their lives.

[scjoe]

Or stay put and call a boat or other divers over for help WHILE you are performing the rescue breaths?..Ever did CPR. Its difficult to perform CPR on land for an extended amount of time by yourself also. It is just very difficult, physically.


I never said that you can perform CPR in the water?

Northern Diver,

Your first quote seems to equate breathing in water with CPR which is why I drew the distinction.

[northen diver]

Northern Diver,

Your first quote seems to equate breathing in water with CPR which is why I drew the distinction.



Or stay put and call a boat or other divers over for help WHILE you are performing the rescue breaths?..Ever did CPR. Its difficult to perform CPR on land for an extended amount of time by yourself also. It is just very difficult, physically.

[derwoodwithasherwood]

PLEASE STOP advocating that rescue breathing is a waste of time. You ARE NOT a doctor are you? All of these agencies are teaching this skill for a reason. Stick to your training. If you disagree with it, so be it, but dont spout off like you KNOW its a waste of time unless you have some real proof.

I am a small cog in the study that supports his statements. That multi-year, multi-phase North American wide study is part of what led to the change in CPR standards to 30:2.

There are always exceptions of course, but there is very strong statistical evidence that compressions are, above all else, the most critical need after the heart stops and should be given precidence over and above breaths. There is usable O2 in the blood stream for some time after circulation stops, even though the levels will be somewhat depleted. We are currently engaged in the next phase of the study which statistically compares 1 minute of initial uninterupted compressions to 3 minutes of initial uninterupted compressions at a rate of at least 100bpm.

So, assume for a moment that the Px has some sort of a pulse but has stopped breathing. What you are facing is a typically degrading situation and can be assured the heart will soon cease to move blood. You have only a very few minutes after that until brain cells start to die -- one figure often bandied about is 6 minutes.

Let us say that the heart stops moving blood efficiently precisely at the moment you make your decision. If you are 5 minutes from shore or a boat, you have 1 minute to get the Px out of the water and start CPR. Good luck with that, but stranger things have happened. If you do 3 minutes of in-water rescue breathing first, you are now 2 minutes overdue when you hit the shore. Now the odds are that much worse.

But let us say that you started rescue breathing immediately on loss of conciousness -- well before the heart stopped moving blood. And let us further suppose that you are skilled, able to maintain a good airway, don't fill the Px with water, do everything perfectly and keep the heart and brain sufficiently oxygenated. What have you accomplished? You are still 5 minutes from shore and 6 minutes from brain death. You are also now getting tired from your efforts.

In My Humble Opinion, considering the above: If you *know* that help is responding promptly to your location, then it makes sense to attempt rescue breathing. Otherwise, you are probably best to get the Px out of the water as soon as possible so you can treat them effectively.

Just my 2˘

[Satori]

For the apneic diver at the surface, ABC's should be initially checked. Airway patency should always be assured (if you don't have an airway, you dont have a patient) The diver may only need a patent airway to ventilat on his own. If diver isn't ventilating on his own, 2 rescue breaths need to be given. Lets assume this is post dive surface breathing... the etiology of altered level of consciousness needs to be questioned. Is this a bad fill? Did the diver get bent/oxygen toxicity? Did the diver have a medical incident such as a spontaneous pneumothorax at depth? Did the diver begin to drown or have a mechanical ostruction? Assuring airway patency and delivering breaths can help you to decide what kind of interventions may be needed, in addition to providing essential ventilation of the unresponsive diver. Compressions can't really be performed effectively in water so I wouldn't even waste time in assessing circulation before reaching a stable surface.

[stevewirl]

hi guys . im a m1 instructor with cmas im also a paramedic . the new compression rate from last year is 30:2 .
as for the rescue breaths it is generaly understood that survival rate decreases between 7-10% for every min the heart is not beating . after 3 mins the o2 starved brain starts to die . my opinion would be to get the victim to the shore and recieve advanced care asap .
BUT.............. as with everything if it in the book its the bible so thats the stance