Woman critical after West Van scuba diving accident - Canada

[Grover48]

I have performed CPR in a Medivac Helicopter. It is close quarters, but doable.

 

[flots am]

The information that I have heard is that the diver ran out of air, and while air sharing to the surface, spat the reg out and sank back down to the bottom. Not sure why, possibly panic.

That's a good reason for the rescuer to have a really good grip on the victim and not let go until the victim is back on land or the boat. You don't want to give someone with proven bad judgement (ran out of air) the option of doing anything else dangerous.

These are always sad.

flots.

 

[Garth]

Over weighted why did she sink to the bottom too fast for other diver to grab her. So sad.

 

[fishguy]

tonka97...

Responders were performing chest compressions when I surfaced. At that point the hovercraft was leaving the beach as the helicopter was arriving. I was more concerned with staying out of the way while also trying to get out of the water. I don't know why they waited the time they did to load her into the helicopter. I'm not one to stop and stare. I'd rather sooner just get out of the way however, at one point a sheet was used to cover her and the responders on the beach as there was quite a crowd on the embankments.

On a side note, Whytecliff is a lot further than 29 minutes from VGH in normal traffic.

 

[ClarkKent]

Would you elaborate on the CPR?

Chest compressions, breaths, AED, oxygen?

35 minutes is a LONG time to perform CPR before air transportation arrives for transport to to hospital. Add time loading person in plane, flight time, landing, unload plane, transport to hospital....this conceivably took another 20-30 minutes (or more).

Driving from the beach to Vancouver General Hospital would have taken at most 29 minutes going the speed limit and stopping at signals, assuming no traffic nightmares. CPR could have been given during the transport. (Speeding with lights flashing, (or police escort) could cut the time in half, say 15 minutes to arrive at hospital)

1. Studies clearly show that CPR in the back of a moving ambulance is less the half the effectiveness of on scene stable CPR let alone inside of a helicopter.

2. The drive that google says takes 29 minutes is with no traffic. Even with lights and sirens that is at least a 30-40 minute transport time. Police escorts are dangerous and no more effective then standard emergency ambulance transport. Lights and sirens DO NOT = Double the speed!

3. ACLS was provided on scene.

4. A patient will not be put in the hyperbaric chamber while in cardiac arrest therefore on scene resuscitation (ACLS) followed by a quick 5 minute helicopter ride (5 min loading time and 2 minutes of rotar cooldown x 2) is the best care in this situation period! Early ROSC (Return of a pulse) is the priority and this is best accomplished with on scene ACLS.

5. From the beach doing ineffective CPR up to the waiting ground BLS would have taken 5-10 minutes and reduced the chance of survival to almost zero.

Respectfully, please don't make assumptions or criticize the work and or treatment provided without knowing how things in this situation work.

CPR merely buys a small bit of time before the AED arrives, and/or emergency treatment at hospital.

Very true, but not all cardiac arrests are treated with an AED, ACLS is what was needed in this circumstance.

 

[tonka97]

Thank you Fishguy. I know you are traumatized as I would be.

I've 'been there'.

Take care.

Prayers for the diver....she needs an angel.

 

[tonka97]

Prayers for diver.

 

[P Stickman]

Tonka, Seriously dude! Google doesn't live here! Any given day ferry traffic on that road causes trafic backing up on the alternating three lane Lions gate bridge. Crossing through stanley park with Sunday sightseers merging with downtown traffic (and don't forget the ferry traffic... now you are in downtown... no major thruways... and you are several shopping districts and yet another bridge from VGH.

When it comes to decision making, I would trust the locals and coast guard to Google Maps info.

 

[ClarkKent]

Just questioning the decision making. Isn't that what we do in order to learn and improve responses to accidents and injuries?

Yes, however, asking questions and making insinuations or suggesting that transport was delayed or that transporting the patient with ongoing CPR / BLS (Proven to be insufficiently effective) would be better then waiting for an Airevac based on a google map is very different. What you have suggested was done so on the basis of a google map and assumptions or presumptions and almost no fact.

I admit I get defensive and angry when people make assumptions and suggestions without all of the facts, local knowledge and education, for this I apologize in advance. So lets change this to educational.

Opportunities may have been missed in this case.

We can always do things better ....

....could have been immediately driven 13 miles to Vancouver General Hospital, with AED activated, airway established, oxygen supplied, and ACLS/CPR as indicated.

Google Traffic predicts that on a Sunday early afternoon, traffic would be FAST on that route to the hospital.

Whytecliff may appear close, and google maps may suggest a 29 minute drive, however, this is at best a 40+ minute transport time (not including extrication) with lights and sirens. The city is dense, with a large number of traffic lights and on an early Sunday afternoon in the summer there is no such thing as light traffic in Vancouver. Google is not always correct.

You must also factor in the extrication times. Whytecliff has a fairly steep and lengthy hill / steps from the beach to the parking lot. In this case, packaging + carrying the patient while doing CPR (which again would be ineffective and detrimental) would take at least 10-15 mins (The Helicopter landed on the beach).

The helicopter was launched the moment the calling party identified this as a diving accident. As a side note Ground ALS arrived at roughly the same time as the helicopter and the patient was not on the beach for 35 minutes before the helicopter arrived.

The priority in this situation is Quality CPR (Emphasis on Quality, not done while hiking up a steep incline / stairs or in the back of an Ambulance "Speeding" down the road, continuously accelerating and decelerating at every intersection) and Ventilation followed by ACLS with an end goal of ROSC (Return of Spontaneous Circulation) ASAP. This is best done at the scene in a stable environment and not in the back of a moving ambulance or helicopter.

CPR merely buys a small bit of time before the AED arrives, and/or emergency treatment at hospital.

As important as AED's are (Very IMHO) the vast majority of OOA emergency's (Hypoxia), AGE (Cardiovascular Collapse / Neuro / PE) and DCS result in a PEA / Asystole. These are types of cardiac arrest where an AED is ineffective and Quality CPR / ACLS is required.

Although ACLS can be provided enroute in a moving ambulance and is done so routinely, in a situation where the ground transport time is greater then that of waiting for an airevac and providing a higher quality of care at the scene is possible, it is better to wait. It is also worth mentioning that the helicopter landed on the beach before the first responders and BLS ambulance would have been able to get the patient to the parking lot.

Tonka, your comments although meant as a learning point cast doubt and insult ALL of the responders and yet you had almost no information when doing so and that is where I take offense on behalf of the emergency responders. Realize that your comments maybe taken as reasonable and gospel by others who know no better.

I wish the patient the best of luck and thank ALL of the Emergency Responders, Rescue Divers and all those involved for helping one of us!


Clark,

Advanced Care Paramedic (12 Years in Vancouver)
HCP BCLS/ACLS Instructor
Rescue Diver

 

[Rick Murchison]

... I admit I get defensive and angry when people make assumptions and suggestions without all of the facts, local knowledge and education, ...

No need... as we say in LA, "Y'all done real good!"
BZ
Rick