Incident report

Hi all....
I wanted to describe a situation I faced last weekend to get your input about the hows and whys.....I still have a few questions. To start with, everyone seems to be suffering no physical effects from this dive.

We were on an open water certification weekend in lake water that was 33-37 degrees, depending on whose computer you read. Myself and another staff diver were with a couple of students who had handled themselves relatively well for the first 4 dives. On the last dive, the students were to set a "floor" of 55 ft, and lead the dive, while we kept an eye on them. Student B seemed fairly overweighted, but it had not been a serious problem over the last 4 dives.
We jumped in, did surface communications, and proceeded to descend, with the students just under the other staff and me. At about 50 ft, Student A signalled Student B to level off, but he kept descending, and I noticed that he did not have his hand on his inflater hose. I swam down and caught him by his BC strap and stopped his descent at about 60'. He slapped my hand away, but then turned to his buddy and signalled OK. They faced each other and seemed to be "settling" Suddenly, Student B removes his reg from his mouth!! At the time I did not notice a free flow. Student A offered his Octo, but I got there first, and put mine in front of Student B's face (we had agreed on surface that a free-flow situation would be handled by a staff-student pair, rather than 2 students). Time elapsed with the reg out was minimal....mebbe 5-10 sec.
He pushed my octo away....offered it again and purged it, thinking he couldn't clear it....he pushed it away again, so I gave him his primary back. He seemed to take a breath, then removed it again....now it was definitely freeflowing!!!!! Bubble chaos began. His eyes were getting huge, and I saw him look up.
I grabbed the back of his neck (meant to grab tank, sorry Student B), and held my octo at his mouth, but he wouldn't hold it, and never used his hand to steady the octo.
We started the ascent. Other staff said that we didnt start to rise for a little while (time is impossible to guess at). I was swimming all I had, but could barely start rising. Again...bubbles everywhere, and I had a hard time telling if we were going up. Student B was flailing a little, and managed to pull my reg out of my mouth, so I had to let the octo away from him to get my air back. We finally started keeping up with our bubbles....by this time Im breathing like a freight train, and my primary starts freeflowing.
Around this time Student B went limp. His eyes were open, but his mouth was slack, and he was dead weight. We continue rising, and my drysuit is puffing up....my left hand is on his neck, so I cocked my elbow to try to vent, but couldnt keep up. Considered venting his BC, but needed my other hand to hold the octo to his mouth. His mouth is open, and some bubbles came out, but not sure if he ever inhaled. 200 years later, we breached the surface....undoubtedly too quickly (again, didnt have my gauges in sight). Got him on his back, and he puked out a bunch of water, and finally answered my question about him being all right. He puked up some white froth on the way into shore.
At debreifing, he says he removed his reg because it was freeflowing, and couldnt breath off my octo because it was also freeflowing. After that, he doesn't remember anything. The instructors examined him (and me), and could find no problems with him neurologically, and his lungs sounded pretty good. I was coughing a fair bit, but didn't feel like I had damaged anything, and have been OK since, except for feeling exhausted.


Questions.....Could this student have been narc'd? Is that why he thought he had a free flow, and that my octo wasn't good? Should I not have purged my octo when I gave it to him the second time? Did he likely lose consciousness on the ascent, or could he have been in a state of "passive panic"? How could I have better handled the situation?
Feel free to flame away....I don't care if I was wrong, I just want to avoid anything like this in the future.
On another note....I've read a lot of posts about ascending with an unconscious diver (which I assumed at the time). You all talked about assessing if there was water in the mask, and wheter to take it off, and debating whether it is better to control ascent rate using your BC or his, etc. Either I suck as a rescue diver, or that is all just posturing. I could not access his BC...or mine, since both hands were busy keeping his head straight and air in front of him, and I kept looking at his eyes, but even if there was water in his mask, I would have been unwilling to let go to remove his mask.
Any input would be appreciated. This incident has shook me a bit, and I would like to be able to dissect it and hopefully put it behind me.....even now, typing this, I have a knot in my belly.

Thanks,
Wetvet

You survived... your student survived... so for starters... you did good!

we have to go back and identify the links in the chain and figure out which ones could have been broken to keep the incident from happening in the first place.

Firstly, you and your student are lucky puppies and we are all glad to hear things seem OK.

Secondly, it's very easy to sit here and pontificate over what should have been done that wasn't and how well or how badly the situation was handled. You did your best and frankly, you both came out of it without permanent injury... so one that front, you did good Wetvet.

From your posting, I'd say the issue was simple: a combination of task-loading, narcosis, lack of training (no muscle memory to take over in times of stress), and thermal stress (read more narcotic-like effect).

What could you do better? Don't know. You have to save yourself and your student. Sometimes decisions are made in split seconds...

I only teach technical programs now and would probably kill hundreds of openwater students a year if they let me teach them... I would have held the reg in the sucker's mouth... maybe. In many years of teaching, I've been lucky, only had a few bolt for the surface or go squirlly, so don't have bags of experience to share with you...

I would suggest though that in cold water conditions, part of your pre-dive briefing should include a "This is what we do if..." module... and include reminders about how to handle a freeflow. Your student was in a state of panic (look at all the factors that contributed to it) and did the wrong thing... a reminder on the surface immediately before descent may possible have made a difference. Don't know.

Anyhow, glad you are OK

Doppler

Thanks for the responses....there was a discussion topside, just as we were about to get in, about freeflows, etc, but next time they will be a little more in depth...I didn't mention narcosis, because I didn't realize that there was a risk in 50' of water...even if it is cold. Doppler....I did hold the reg in his mouth.....just barely resisted the urge to purge it....glad I didn't in retrospect.

Wetvet

I think I recall seeing that it was considered "near drowning" if the victim ever lost conciousness underwater, and that anyone experiencing such an event should immediately go to the hospital. I think the risk is that if there was any water inhaled into the lungs that the victim could develop a severe case of pneumonia within 24 hours. Unless I was feeling really sick, it would be hard for me to decide to do this. But it seems like this may be a serious enough condition to keep it in mind. Salt water is supposed to be worse than fresh.

scenario the reg may or may not be in the victims mouth. If its not you don't worry about it so that would have freed up one hand in your situation. Water in the mask probably not a problem with your situation but I am wondering why you would be hesitant to remove the mask if doing so was indicated. I find that by linking my left arm under the victims left arm I have both inflator/ deflator hoses close to each other which should allow access to both as needed. Try this and see what you think.

By the 4th or 5th dive I would think that the issue of being overweighted should have been addressed. It could be that since you are working with students in those water temps the pool training should be very strong on dealing with a free flowing regulator to prevent the studnet from refusing it as this one did.

Very seldom does any rescue ever go really well i.e storybook perfect. Most will seem like a charlie foxtrot when you compare it to what you were trained to do. Don't let that part worry you too much. Your actions were appropriate IMHO and all involved survived to dive another day.

Your post is a very strong reminder that all of us need to practice rescue skills on a regular basis especially if we are working with new students.

Thanks for sharing with us.

Seems a similar incident happened to me February, a year ago. Only water was 57 degrees at 30 feet. Student doesn't remember anything but not being able to breath. The student failed to maintain bouyancy, was disoriented and in panic. Tended to float in and out of consciousness after I got the student to the surface. Same white foam in mouth with lots of coughing. Quick recovery after warming up, and breathing O2 for about 20 minutes. I was lucky to have an EMS Tech-DM with me to do a full observation.

I read an article in the DAN Alert Diver that identified a rare condition is some people that was caused by a sensitivity to cold that causes an extreme reaction. I believe the article mentioned it being a life threatening condition. And I don't think it was necessarily because the person might be underwater at the time.

The Alert Diver issue would have been the one that came out around Feb/Mar 2002. Might want to check it out.

Sounds like you may be talking about Raynaud's Phenomenon

Symptoms of RP depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration upon cold exposure. They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal. When the blood vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen, and can cause pain in the involved digit(s). Rarely, poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected. With continued lack of oxygen, gangrene of the digits can occur.

Less common areas of the body that can be affected by RP include the nose, ears, and tongue. While these areas rarely develop ulcers, they can be associated with a numbness sensation and pain.

Patients with secondary RP can have symptoms related to their underlying diseases. RP is the initial symptom of 70% of patients with scleroderma, a skin and joint disease. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome. For further information, please read the Systemic Lupus Erythematosus and Rheumatoid Arthritis articles.

How is Raynaud's phenomenon diagnosed?

In patients with the characteristic sequence of skin color changes of the digits upon cold exposure, diagnosing of RP is not difficult. Sometimes, certain patterns in the tiny blood vessels (capillaries) adjacent to the fingernails of patients with RP can be seen using a magnifying viewing instrument. Abnormal nailfold capillary patterns can suggest the possibility of an associated rheumatic condition. There is, however, no single blood test to help the doctor to confirm the diagnosis. The doctor can order certain blood tests (for example, sedimentation rate, rheumatoid factor, antinuclear antibody , thyroid hormone levels, and protein levels) to exclude associated rheumatic diseases. The doctor can also perform certain maneuvers with the patient's extremities to exclude pinched blood vessels that can produce symptoms that mimic RP.

Typically patients with Raynaud's phenomenon that is a manifestation of a rheumatic disease have elevated blood sedimentation rates and antinuclear antibodies. Furthermore, capillary nail fold abnormalities can frequently be found as described above.

How is Raynaud's phenomenon treated?

Management of Raynaud's phenomenon involves protecting the fingers and the toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasm should be avoided by patients with RP. In patients with persistent symptoms, medications which dilate the blood vessels can be administered.
Source:http://www.medicinenet.com/Diseases_And_Conditions/Alpha_R.htm

Not a doctor

jbd once bubbled...
Your actions were appropriate IMHO and all involved survived to dive another day.

Click to expand...

I agree that you did a great job. I think you should be proud of yourself, because you probably saved this guys life.

Diving carries some level of risk, and while we can help out our buddies, students or even strangers, if someone is so far gone that they can't function at all we may not be able to pull them through.

Realistically what you had to deal with was a person who is under water, refuses sources of air, is of no help in making way for the surface, interferes with his rescue, and to top it off the whole scene is aggravated by a free flowing regulator!

I would say your efforts were heroic and you endangered yourself to save this person.

A few comments:

I'm not sure that "dive another day" is appropriate in this situation. If the diver was properly trained then there is no reason not to continue breathing from a free flow or at least switch to the octo. I don't know what happened to this person, but if I was the instructor I would not certify this guy unless I could adequately explain what happened to him and be sure it wouldn't happen again.

There were probably some "holes" in the training. Weighting was not right, which is typical of OW certifications, but that is no excuse. Of course this may not have anything to do with what happened. The other question is whether the student was trained to deal with a free flow. I don't know why no one practices this at least once. It's easy. Just push the button.

When I saw "incident report" I thought it was going to be another fatality. It may well have been had it not been for your decisive action.