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Thread: What to do in certain situations

 


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    Mndiv's Avatar
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    Question What to do in certain situations

    Hey everyone, the other day i had this thought, if I was faced with an unconscious buddy underwater, rapid ascent of my buddy or myself, or DCS at the surface would I know what to do??

    I currently have my OW certification, and although I am taking CPR and Lifeguard training this summer to better prepare myself for diving related emergency's I have not (yet, I am positive I will) taken the rescue diver course.
    We personally dont have Oxygen O2 with us in case of emergencies as we (my dad and I) are relatively new divers and realistically we wont for a while. We are both insured through DAN and calling them after 911 is to me the only obvious step to take.

    If Im being real honest I dont have much of clue what to if you have an unconscious buddy at depth, you have a rapid ascent due to something like weight loss or your buddy does, or my buddy is unconscious/has bad DCS at the surface. What would I do? I ask myself.

    After realizing that other than some obvious steps like calling DAN i dont really know, so i took it to the scubaboard forum to get some solid advice from you guys. What would you do in my situation?

    Thanks so much for the advice!
    Looking for dive buddies in the Twin Cities, MN!

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    Simon-'s Avatar
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    To be honest, you have answered your own question on your profile page in the SB Challemge section- Rescue Diver.

    I appreciate that you are only OW certified, and would need to be Adventure Diver (with navigation completed) to start the rescue course.

    It is great that you are situationally aware and thinking of scenarios such as these. I wish more new divers were less tunnel visioned in their approaches.

    An O2 kit is not particualrly expensive to buy, and if you are diving on your own (not with a dive centre etc), then I would certainly advocate having O2 close to your entry/exit point. The training to use the kit is not complicated and only takes a short time.

    You could consider contacting your LDS or an independant instructor to ask if they could give you some training sessions in advance of a rescue course.
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    freewillie's Avatar
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    Rescue diver course and a good dose of common sense.

    Time will generally the the over riding factor. You want to get medical attention ASAP. Make as rapid an ascent that is still safe, but in this instance you omit any safety stop obligations. Since arterial gas embolism and decompression illness are both treated O2 then either way get the diver on oxygen. Keep the victim comfortable and if possible warm with blankets/towels, etc. CPR if unconscious and not breathing. Seek medical attention as soon as possible.

    Safety also starts prior to a dive. Good buddy check prior to getting in water. If diving with an instabuddy you should discuss things like what to do if separated. Safety gear should include a surface marker buoy and whistle. I also carry a signaling mirror with me and line cutter in kelp. You need to attract the attention of the dive boat crew if diving on a boat. Whistle much better than shouting.

    And, God willing, you won't have to worry about an emergency. But if you do see above.
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    Nevermind.

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    lots of local shops have fun dive nights or weekends at square lake or at the quarry in wisc. Call each of the shops in the area and find out their schedule. You can also rent tanks or get fills from the shop. It is a good way to meet local divers and to dive with more experienced divers who would be happy to discuss your concerns.

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    Quote Originally Posted by Mndiv View Post
    what to if you have an unconscious buddy at depth,
    In short - Get them to the surface, as quickly as possible, without placing yourself at risk.

    The rescue diver course expands on this principle, and provides specific techniques for doing so. For instance, it differentiates steps to take depending on whether the casualty has the regulator in their mouth (assume breathing/not drowned) or whether the casualty has dropped their regulator out (assume not breathing/drowned).

    If the regulator is in their mouth and/or they are breathing, retain the regulator in their mouth during ascent.

    If the regulator is out of their mouth, do not replace it... ascend immediately.

    Maintain a safe ascent rate.

    Establish victim and rescuer positive buoyancy immediately upon surfacing.

    See steps for unconscious buddy (below).


    Quote Originally Posted by Mndiv View Post
    you have a rapid ascent due to something like weight loss or your buddy does,
    Exit the water, observe the victim for signs/symptoms of DCI. Re-hydrate and rest.

    Provision of pre-cautionary O2 is highly debatable, as it can mask symptom presentation... but could also prevent DCI occurrence/worsening.

    Cease diving for sufficient period to ensure that late-onset DCS does not present (normally 8-24 hrs, depending on severity of rapid ascent and prior diving profiles).

    Quote Originally Posted by Mndiv View Post
    my buddy is unconscious...at the surface.
    Raise alarm / call for assistance.

    Establish if victim is breathing (you are unlikely to find a pulse - so breathing is the best determination of cardio-respiratory function).

    If breathing, protect the airway and evacuate the casualty from the water immediately.

    If not breathing, you can provide artificial respiration in the water during evacuation/exit from the water. However, if you suspect the casualty also has no pulse (possible) then artificial respiration is unlikely to have any positive effect (full CPR is needed) - and thus will only slow down the evacuation from the water and lengthen the time before the victim can receive full CPR. If you suspect that the victim has no pulse, your priority is immediate evacuation from the water, disregarding in-water artificial respiration.

    Upon exit from the water, commence CPR first-aid for the victim (Airway-Breathing-Circulation)...including AED if available.

    Evacuate casualty to emergency medical care.

    Quote Originally Posted by Mndiv View Post
    my buddy....has bad DCS at the surface.
    If unconscious, treat as per an unconscious victim (above).

    If conscious, evacuate from the water.

    Lie casualty down, on their left-side.

    Administer O2, or otherwise highest %O2 gas available (i.e. nitrox)

    Monitor casualty, noting onset/variation of symptoms.

    Provide First Aid as per a victim suffering from shock. Be prepared to administer CPR, O2 enriched if possible.

    (Re-)Hydrate casualty.

    Arrange immediate emergency medical evacuation for any casualty with DCS, regardless of severity.

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    Why are you waiting until summer to take the CPR class?

    At present, you have basic OW training and very limited experience. Be careful about getting into situations that are over your head. One of the worst things you can do as an emergency responder is turn yourself into another victim.

    That being said, many of the scenarios you described can be addressed with "common sense." All of the scenarios would certainly be discussed in a rescue class.

    Here are brief descriptions of approaches to the various scenarios:

    • Unconscious buddy underwater: Get him to the surface as expeditiously and safely as possible without subjecting yourself to excessive risk. In the vast majority of cases, this would entail you making a controlled ascent with him. Establish positive buoyancy at the surface. Get help.
    • You experience a rapid ascent: Try to arrest the ascent and regain control. If you can't do that, try to slow down as much as possible and breathe continuously on your way to the surface (keep an open airway). Once you reach the surface, establish positive buoyancy. Monitor yourself for decompression illness (DCI) symptoms. Communicate with your buddy to let him know how you're doing. Get help if necessary. Consider not diving anymore that day.
    • Rapid ascent of buddy: If you are certain that your buddy is not experiencing a medical issue (and, therefore, needs to get to the surface ASAP), help him regain buoyancy control. If you are unable to help him arrest the ascent, help him slow the ascent as much as possible. Breathe continuously during the ascent. If you aren't in a position to intercede during his rapid ascent, let him go...and ascend behind him at a safe rate. Once you reach the surface, check on your buddy. Establish positive buoyancy for both of you. Remain on the surface and consider not diving anymore that day. Monitor your buddy for signs/symptoms of DCI. If your buddy is experiencing DCI symptoms, call 911. Contact Divers Alert Network if you are unsure whether your buddy is suffering from DCI.
    • Suspected DCS at the surface: Call 911. Or present the victim to the nearest ER with a hyperbaric chamber.


    In the above scenarios, you'll note that there's a common theme in the recommended courses of action -- get to the surface safely, establish positive buoyancy, monitor for DCI, get help/activate EMS/call DAN.

    Divers Alert Network has posted a nice essay on DCS treatment. Feel free to read it if you're interested.

    FYI, an emergency action plan requires knowledge of: (1) the location of the nearest hyperbaric chamber, (2) the location of the nearest ER, and (3) how to activate EMS. Most shore divers will have a cell phone in their car. If that's the case, make sure you have a way to get into your car. It would suck to have the only set of car keys attached to your buddy who is trapped underwater somewhere. As a backup plan, it might be prudent to know where the nearest payphone or house is.

    As a diver without any formal rescue training, I think it's important not to bite off more than you can chew. Use your common sense. Use judgment to decide when it's appropriate to turn over the situation to a trained rescuer. Do the best you can without turning yourself into another victim.
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    Quote Originally Posted by Simon- View Post
    I appreciate that you are only OW certified, and would need to be Adventure Diver (with navigation completed) to start the rescue course.
    Only if he feels the need to stay with PADI. NAUI and SEI both have very good Rescue Diver courses, and neither require anything other than OW.
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    It is unlikely that anyone can improve upon DevonDiver's comments on appropriate actions. Knowing them and doing them are two different things, though, so do continue you diver education and include a rescue diver class. I think that freewillie's point about prevention of emergencies through proper dive planning, equipment maintenance and safe diving practices is as important as any thing else raised in the thread. On the O2 question, when diving with LDS groups or on dive boat charters, it is always present. Often when Debbie and I dive alone we have a small O2 unit available, but not invariably. In those case we do not, we are careful to know where the nearest one is- sometimes at a health station at a nearby hotel, or lifeguard or security station, or elsewhere. It is by far the better practice to have a unit available on site whenever possible.
    In every rescue situation, be sure you are always in a position for self rescue. For example, if another diver is ascending out of control and your preventative steps do not slow them, release them or there will be 2 casualties instead of one. This and all of the other scenarios you mention, and more, are covered in the rescue diver class of each of the main certification agencies.
    DivemasterDennis

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    It's wonderful that you are asking these questions, especially since you dive with your dad. Older people are more likely to get into health-related issues in the water, and learning how to surface someone under control, and how to get them out of the water, is very good practice. I strongly recommend Rescue for every diver -- at least the PADI Rescue class (which is the one I know) is a VERY good overview of two things: How to handle emergencies, and how to think about your diving to avoid them in the first place. You can't do too much to avoid health issues, except try to keep yourself fit and not ignore any warning symptoms. But you can do a great deal to avoid other kinds of diving emergencies, by planning your dive (including your gas supply!) and practicing your skills so that you stay sharp with them.
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