Searching for opinions about Rescuing a diver and decompression stop

Hello,

I'm training for a certification which plan to give us something a little like "rescue diver" and "deep diver of PADI" (with a limit of depth of 60m).

In our courses, we are teaching how to rescue an unconscious diver.

The (simplified) procedures is the following :
- we put the regulator of the victim in the mouth of the victim, and keep it here with one hand. (The same hand keep the victim close to us).
- With the other hand, we use the BCD (own's or the victim's bcd) to raise up and keep a constant ascent rate (not too slow, but not too quick).
- We don't stop to do decompression stop, and we will do them in the hyperbaric chamber.

If we do just a "light" dive with very little decompression stop (say something less than 5 min total stop), I can agree, even if I never seen a diver be treated in an hyperbaric chamber in less than 1 hour after the incident so the "easy to access" chamber is a bit obscure to me.


Does this procedure is useful in the case we do some more "engaged" diving, like a 55m / 35 min diving I've got more than 1 hour of deco stop (1 min at 12m, 9 min at 9 m, 23 min to 6m and 50 min to 3 m) ,and my buddy too!


I don't think that a "blow up" decompression sickness could be treated in an hyperbaric chamber, and I give me very little chance of survival if I decide to not follow the decompression stop.


In addition, my instructor does think that nor me, nor the group of diver of the diver, must go down once the victim is safe on the boat and do deco stop I couldn't do when doing the rescue.
1°)"if emergency teams wants to move the boat to go to the hyperbaric chamber, they can't"
2°)"In Water Recompression are forbidden when hyperbaric chamber aren't very far away." (you can't have a true medical help when in-water).)
(Even if it's just doing deco stop we haven't do, and not a medical recompression).
3°) "Diving is a dangerous sport, but you aren't forced to make dangerous activities to have fun" (I'm not too sure if he wanted to say "do only light deco diving" or "you know the risk, you must follow the rules even if its really risky for you").


In case of "heavy" deco stop, do you think it's better to prevent any new casualities, and consider the unconscious diver as a "lost cause" (if he survive at least, he wouldn't have a big decompression sickness, but if he have a respiratory or cardiac failure, he is dead) and do your deco stop (as your group), or you are faithfull on the hyperbaric treatment and a live is something important and you must take the risk to help him ?

First rule of rescue is don't turn yourself into another victim ... all that accomplishes is to complicate the situation and reduce the resources available to the person you're trying to rescue.

If it were me, and I had to blow off a little bit of deco, I would do so ... coming up slowly to reduce my risk of a hit. If I felt my deco obligation were beyond an acceptable point, I would come to my first deco stop and remain there ... possibly "sending" the victim to the surface if I knew resources were on standby to receive him there.

By blowing off your deco and then attempting an in-water recompression you are increasing your own risks ... and potentially preventing the boat from getting the initial victim to emergency care. By honoring your own deco obligation, you are reducing your own risks, and if the boat needed to leave, they could drop a buoy, put a safety diver in the water to assist you, and move off station to get the victim to care.

There are never cut and dry answers to these scenarios ... you have to evaluate both your risks and resources and make an informed decision. But for the most part, your decisions should revolve around not putting yourself at excessive risk of also needing treatment ...

... Bob (Grateful Diver)

Thanks a lot for your answer (more than you can imagine).

I was asking myself if my first aid knowledges doesn't apply in diving and I must have strong denial of myself in a rescue operation.

Now, I must be careful to never be in a situation to be rescued from a deep and long dive by my actual instructors

(I do thinks they're are very good in most of our instruction, but perhaps a little to "formatted" by the way of doing thing in the organization, or doesn't want that their pupils thinks too much about "what to do" when an emergency occurs).


Of course if anyone have other arguments/points/idea, there are welcome.

I agree with Bob, don't turn yourself into the second victim.

Whether you can 'send' the casualty to the surface to be taken to shore and you continue your deco will depend on how far from shore you are, and time of day. Unless there are other boats about it might not be possible to make the return trip to the shore and back in a safe time to leave you bobbing around after your deco stop.

As far as going back down after bringing the casualty up I would say no - there is no guarantee this will reverse any DCI which may have manifested itself as you surfaced, and it is not controlled environment so you can't guarantee pressure etc, all medical advice says give 100% oxygen in DCI cases, you can't get that whilst doing in water deco.

If their regulator is out they are not breathing, and may have lungs full of water, if I believed there was a chance of recovering the diver to the surface I would bring them up at as safe an ascent rate as possible, foregoing the safety stops, then high tail it for the nearest hyperbaric chamber using 100% oxygen. Hopefully someone else would be available to do CPR and try to 'resucitate the other diver I could concnetrate on myself and not getting too stressed etc until I hit the chamber.

But then my training is air only and recreational depths i.e above 40m but we did discuss how to handle this sort of situation when we had incurred a deco obligation, but nowhere near as heavy as one hour.

I would think if the regulator was out and casualty not breathing casualty you only really have matter of minutes to recover the casualty to the surface to have any success of resucistation unless it is very cold water. If you have a heavy deco obligation this just will never stack up and coming up from depth with a non breathing diver is unlikely to ever be successful

I think a recreational diver should avoid going into deco, since he was never trained to do a deco dive. If you're not in deco then you don't have the possibility of having to do a rescue in deco.

I'll have the agree with the two above posts as well, you don't want to make the situation worse by adding to the victim count. By trying to recompress underwater, you put yourself at risk of needing an in water rescue, this puts more rescuers at risk while they come to save you. On top of that it's probably near the end of a dive, meaning there's a lack of available air to make that rescue.

It's better to breath 100% O2 on land and make a trip to the hyperbaric chamber IMO.

Having said that, I've DM-ed aboard a tec-boat trip before and the captain and dive team's agreed upon rescue procedures were: If a diver needed immediate medical assistance and we still had divers in the water doing deco, we would then radio the Coast Guard and stay on station until the remaining divers finished their deco. Until then the Coast Guard would have the ability to transport the victim to the hyperbaric chamber.

Speculating here, but I'm sure there are plenty of different rescue techniques taught in the tec classes. Two that come to mind are:
A) What your instructor mentioned, taking the unconscious diver up yourself and going to the hyperbaric chamber for treatment. This isn't ideal especially if you have to wait for other divers to finish deco. Those divers are not obligated to blow their deco.

Another option (which I see as more ideal)
B) Send up a DSMB and slate, clip diver to line, send diver up. If the boat crew is doing their job right, they'll be scanning the ocean and see your DSMB, and later the unconscious diver. They'll then respond with a surface rescue and take over from there.
They're not leaving if there are multiple deco-divers in the water, and the unconscious diver is dead if he stays underwater, so this is the best solution to minimized the amount of possible victims IMHO.

I'm sure some tec divers could chime in here with more knowledgeable advice.

Thanks for all your answer.


I think I need to be a little more specific : I never intend to revert a DCI, If i've got a DCI when I ascent (at safe rate) with the victim, I will stay on surface.


But actually my organization give us a procedure to make deco stop which aren't finish (going to surface before finishing all your deco stop) : procedure "A", or a procedure when we've got an uncontrolled ascent : procedure B.

A : If you can go down in less than 3 min at the depth of your last stop, then you make all the stop again, and you are doing other stop normally.
Else, wait for the hyperbaric chamber.
B : You must go down to half you max depth, stay here 5 min, and from here. Once it's done, you consider you determine your deco stop from this time (for example : i'm doing a dive of 35m for 25min. At this moment I'm doing an uncontrolled ascent, and as soon as I attain the surface, I go down to 15 m, and wait here for 5 min.
The dive parameters i will take into account for my deco stop are : 35m and 25+5=30 min ).


So one of my many questions were "must I use them once I've bring the victim" .
Knowing that with an as heavy deco as in the example, I'm praticaly sure that anyone would got a DCI just bypassing all theses stops.
I've done some calculus with the 55m dive withtout respecting the surface, and some compartiment got more than 4.25 bar of dissolved gaz when the diver come at the surface...




In addition, I think we all agree on the fact that if we have very little deco stop to do, we will take the risk to bring to victim on surface, and waiting for the hyperbaric chamber with O2.

If I've got a DCI bringing the victim, I wouldn't want do in water recompression withtout good reason in a recreation dive (as theses need specific tables like US NAVY recompression table/..., as you've pointed it, a good supply of oxygen, a specifically trained support diver, ...)


One good things I see in this discussion, for me at last, is that I'm not the only one to think that way (doesn't cause a new accident, and so on)

I think we are having some communications limitation inherent in using a language that is not a first language. However, if the victim is breathing, why can't they do a stop with you? If they are not breathing, I like the "send them on and you tend to your own safety" approach. But that assumes that there is someone above to retrieve the non-breathing person. As far as re-entry after surfacing to "make up" a deco stop, I do not endorse that idea. I believe you are better off getting yourself on O2 as a preventive measure, but I would love to hear what others think about re-entry and doing a "make up" deco stop.
DivemasterDennis

If you and your buddy did 35 min at 55 meters and the diver is not breathing on the bottom, the chance of him living is very slim. I think I would probably send the diver to the surface and hope that surface people will take over. If nobody was on the surface to help, I would not go to the surface and try to rescue the diver. I would probably just do a full deco with their body clipped off to me.

If I did ascend to the surface after that kind of profile, I would go back down. Hopefully if you are doing that kind of deco diving, you have oxygen in a scuba tank and can take it down and do deco.

Phil_C:

I agree with Bob, don't turn yourself into the second victim.




As far as going back down after bringing the casualty up I would say no - there is no guarantee this will reverse any DCI which may have manifested itself as you surfaced, and it is not controlled environment so you can't guarantee pressure etc, all medical advice says give 100% oxygen in DCI cases, you can't get that whilst doing in water deco.

Click to expand...

This statement is not true. There absolutely SHOULD be oxygen available to take down and do the oxygen deco?? I am baffled why you would give advice to indicate otherwise? Do you do deco diving? Do you have any experience in this topic?

Dennis - for me going back down is a definate no, and is how I was taught. Going back down assumes there is still going to be someone topside to wait for you, which might not be the case if the boat needs to leave with the casualty and there isn't another boat around, secondly if you are not bent (and I appreciate DCI can manifest itself later) then going back down serves no purpose, and you can be better monitored and watched by the boat crew and go to the chamber with the casualty, and if you are already bent then 100% oxygen and a quick trip to a chamber is the answer and much more effective than trying to go back down.

Also if you get a serious DCI which incapacitates you when you have gone back down (because going back down is no guarantee you haven't already got a DCI starting and descending again may not reverse it) then you are in a worse situation than having a DCI on the boat on the way to the chamber.

So for me an obvious choice - I have surfaced I stay there