The untold story of the daring cave divers who saved the Thai soccer team

[Compressor]

The highlight of my recent trip to OZTek in Sydney last weekend was the 1hr talk by Australian cave rescuers Craig Challen and Dr Richard Harris. Each spoke in detail for 30mins and then questions at the end... three detailed questions by other 'Dr Divers'.

One of the big takeouts was how Dr Harris had originally discounted sedating the kids early on as the risks were deemed too great. As time progressed Ketamine became the 'least worst' option... he was then resigned to a level of fatalities, but thought at the most optimistic 50% would make it out alive.

He had to send the first two off with no immediate way of knowing if they had survived or not, so delayed sending others till he heard back via the chain of divers and helpers along the route. Another issue was having to keep the kids in the sedated state along the rescue route (which took 2-3 hours) via additional doses delivered IM into their leg through their wetsuits... appropriate doses for Big Kids or Small Kids were set up in bags to be administered by local helpers given a crash course in medicine. Dr Harris admitted he was amazed, but delighted the success rate was 100%.

An amazing team effort by all concerned!

AMAZING.

 

[Dr Simon Mitchell]

Hello,

I was invited by the Association of Anaesthetists of Great Britain and Ireland to write a citation for Harry in receipt of their Pask Award. The text is pasted below and speaks for itself. Anyone inspired by the rescue will probably find it interesting. I have also attached the pdf of the citation.

Simon M

PASK AWARD CITATION: DR RICHARD HARRIS


Dr Richard (Harry) Harris was born in Adelaide, Australia, and completed his medical degree at Flinders University. He was awarded his Fellowship of the Australian and New Zealand College of Anaesthetists in 1998. From childhood Harry was a passionate diver, and more latterly developed expertise in cave diving; known for its lethal potential for becoming lost and exhausting one’s gas supply. His unique combination of anaesthesia training and reputation as a world class cave diver destined him to become a central player in what history will record as arguably the most extraordinary search and rescue mission ever undertaken.


On 23 June 2018 twelve boys and their soccer coach entered the Tham Luang cave in Thailand for a team building experience. Torrential rain caused the cave to flood and forced the boys to retreat over 2.5 kilometres underground where they became trapped by long convoluted passageways filled with fast flowing murky water that was not expected to recede for months. It was nine days before British divers Richard Stanton and John Volanthen found them and laid the line that facilitated access to their refuge through zero visibility water by other dive teams. Elation at finding the children was rapidly tempered by the realisation that the only viable option for their rescue was diving them out through a cave system that was proving challenging to some of the world’s best cave divers, and which tragically claimed the life of a Thai Navy SEAL. It seemed impossible that untrained non-swimming children could make this arduous underwater journey without panicking and drowning.


Harry was asked to undertake multiple risky dives into the cave and to consider deeply sedating each child who would then be brought out by an escorting diver. Published guidelines expressly discourage attempts to keep unconscious divers underwater because of difficulty protecting the airway and the danger of drowning. But Harry judged that he had little choice but to set aside these guidelines and embark on a hazardous procedure never before undertaken. With no monitoring or immediate support, he calmly anaesthetised each child with oral alprazolam and intramuscular ketamine. He supervised the critical processes of fitting the full-face diving masks to protect the airway, and deployment of the children with the escorting divers.


Using this approach every child and the coach were safely brought out of the cave to unprecedented international acclaim.


The general public will never fully appreciate the enormous responsibility that Harry voluntarily assumed in this rescue, but anaesthetists are uniquely placed to understand it. When managing a desperately ill patient for whom hazardous intervention is the only option that may save life, we may rationalise bad outcomes by telling ourselves “we had no choice and did our best”. But that same rationalisation would have been of little comfort to Harry when contemplating a repetitive, unconventional and dangerous anaesthetic intervention in healthy boys whose fate was being watched by the entire world, and whose desperate parents and families were waiting outside. The implications of even one adverse outcome are as obvious as they are unpalatable, and seen through that lens, Harry’s actions were not only technically expert but also extraordinarily courageous.


Harry is known in both the diving and medical communities as an extremely modest, unassuming, quiet achiever. Although grateful, he would be very uncomfortable receiving this award without acknowledgement of his steadfast view that he was part of a large team, and that all its members contributed significantly to the outcome. Harry would also undoubtedly want to acknowledge his wife Fiona and their children James, Charlie and Millie who have spent many long and often anxious days waiting for him to return from cave diving expeditions.


Finally, it remains to observe the palpable similarities between Harry and the patron of this award. Dr Pask was another who was prepared to push boundaries and take personal risks in pursuit of scientific truth and better outcomes for all. There no doubt he would be proud to see his eponymous award go to Dr Richard Harris.


Professor Simon Mitchell
Head of The Department of Anaesthesiology
University of Auckland, New Zealand

 

[tursiops]

Hello,

I was invited by the Association of Anaesthetists of Great Britain and Ireland to write a citation for Harry in receipt of their Pask Award. The text is pasted below and speaks for itself. Anyone inspired by the rescue will probably find it interesting. I have also attached the pdf of the citation.

Simon M

PASK AWARD CITATION: DR RICHARD HARRIS


Dr Richard (Harry) Harris was born in Adelaide, Australia, and completed his medical degree at Flinders University. He was awarded his Fellowship of the Australian and New Zealand College of Anaesthetists in 1998. From childhood Harry was a passionate diver, and more latterly developed expertise in cave diving; known for its lethal potential for becoming lost and exhausting one’s gas supply. His unique combination of anaesthesia training and reputation as a world class cave diver destined him to become a central player in what history will record as arguably the most extraordinary search and rescue mission ever undertaken.


On 23 June 2018 twelve boys and their soccer coach entered the Tham Luang cave in Thailand for a team building experience. Torrential rain caused the cave to flood and forced the boys to retreat over 2.5 kilometres underground where they became trapped by long convoluted passageways filled with fast flowing murky water that was not expected to recede for months. It was nine days before British divers Richard Stanton and John Volanthen found them and laid the line that facilitated access to their refuge through zero visibility water by other dive teams. Elation at finding the children was rapidly tempered by the realisation that the only viable option for their rescue was diving them out through a cave system that was proving challenging to some of the world’s best cave divers, and which tragically claimed the life of a Thai Navy SEAL. It seemed impossible that untrained non-swimming children could make this arduous underwater journey without panicking and drowning.


Harry was asked to undertake multiple risky dives into the cave and to consider deeply sedating each child who would then be brought out by an escorting diver. Published guidelines expressly discourage attempts to keep unconscious divers underwater because of difficulty protecting the airway and the danger of drowning. But Harry judged that he had little choice but to set aside these guidelines and embark on a hazardous procedure never before undertaken. With no monitoring or immediate support, he calmly anaesthetised each child with oral alprazolam and intramuscular ketamine. He supervised the critical processes of fitting the full-face diving masks to protect the airway, and deployment of the children with the escorting divers.


Using this approach every child and the coach were safely brought out of the cave to unprecedented international acclaim.


The general public will never fully appreciate the enormous responsibility that Harry voluntarily assumed in this rescue, but anaesthetists are uniquely placed to understand it. When managing a desperately ill patient for whom hazardous intervention is the only option that may save life, we may rationalise bad outcomes by telling ourselves “we had no choice and did our best”. But that same rationalisation would have been of little comfort to Harry when contemplating a repetitive, unconventional and dangerous anaesthetic intervention in healthy boys whose fate was being watched by the entire world, and whose desperate parents and families were waiting outside. The implications of even one adverse outcome are as obvious as they are unpalatable, and seen through that lens, Harry’s actions were not only technically expert but also extraordinarily courageous.


Harry is known in both the diving and medical communities as an extremely modest, unassuming, quiet achiever. Although grateful, he would be very uncomfortable receiving this award without acknowledgement of his steadfast view that he was part of a large team, and that all its members contributed significantly to the outcome. Harry would also undoubtedly want to acknowledge his wife Fiona and their children James, Charlie and Millie who have spent many long and often anxious days waiting for him to return from cave diving expeditions.


Finally, it remains to observe the palpable similarities between Harry and the patron of this award. Dr Pask was another who was prepared to push boundaries and take personal risks in pursuit of scientific truth and better outcomes for all. There no doubt he would be proud to see his eponymous award go to Dr Richard Harris.


Professor Simon Mitchell
Head of The Department of Anaesthesiology
University of Auckland, New Zealand

Most excellent.

 

[TrimixToo]

Hello,

I was invited by the Association of Anaesthetists of Great Britain and Ireland to write a citation for Harry in receipt of their Pask Award. The text is pasted below and speaks for itself. Anyone inspired by the rescue will probably find it interesting. I have also attached the pdf of the citation.

Simon M

PASK AWARD CITATION: DR RICHARD HARRIS


Dr Richard (Harry) Harris was born in Adelaide, Australia, and completed his medical degree at Flinders University. He was awarded his Fellowship of the Australian and New Zealand College of Anaesthetists in 1998. From childhood Harry was a passionate diver, and more latterly developed expertise in cave diving; known for its lethal potential for becoming lost and exhausting one’s gas supply. His unique combination of anaesthesia training and reputation as a world class cave diver destined him to become a central player in what history will record as arguably the most extraordinary search and rescue mission ever undertaken.


On 23 June 2018 twelve boys and their soccer coach entered the Tham Luang cave in Thailand for a team building experience. Torrential rain caused the cave to flood and forced the boys to retreat over 2.5 kilometres underground where they became trapped by long convoluted passageways filled with fast flowing murky water that was not expected to recede for months. It was nine days before British divers Richard Stanton and John Volanthen found them and laid the line that facilitated access to their refuge through zero visibility water by other dive teams. Elation at finding the children was rapidly tempered by the realisation that the only viable option for their rescue was diving them out through a cave system that was proving challenging to some of the world’s best cave divers, and which tragically claimed the life of a Thai Navy SEAL. It seemed impossible that untrained non-swimming children could make this arduous underwater journey without panicking and drowning.


Harry was asked to undertake multiple risky dives into the cave and to consider deeply sedating each child who would then be brought out by an escorting diver. Published guidelines expressly discourage attempts to keep unconscious divers underwater because of difficulty protecting the airway and the danger of drowning. But Harry judged that he had little choice but to set aside these guidelines and embark on a hazardous procedure never before undertaken. With no monitoring or immediate support, he calmly anaesthetised each child with oral alprazolam and intramuscular ketamine. He supervised the critical processes of fitting the full-face diving masks to protect the airway, and deployment of the children with the escorting divers.


Using this approach every child and the coach were safely brought out of the cave to unprecedented international acclaim.


The general public will never fully appreciate the enormous responsibility that Harry voluntarily assumed in this rescue, but anaesthetists are uniquely placed to understand it. When managing a desperately ill patient for whom hazardous intervention is the only option that may save life, we may rationalise bad outcomes by telling ourselves “we had no choice and did our best”. But that same rationalisation would have been of little comfort to Harry when contemplating a repetitive, unconventional and dangerous anaesthetic intervention in healthy boys whose fate was being watched by the entire world, and whose desperate parents and families were waiting outside. The implications of even one adverse outcome are as obvious as they are unpalatable, and seen through that lens, Harry’s actions were not only technically expert but also extraordinarily courageous.


Harry is known in both the diving and medical communities as an extremely modest, unassuming, quiet achiever. Although grateful, he would be very uncomfortable receiving this award without acknowledgement of his steadfast view that he was part of a large team, and that all its members contributed significantly to the outcome. Harry would also undoubtedly want to acknowledge his wife Fiona and their children James, Charlie and Millie who have spent many long and often anxious days waiting for him to return from cave diving expeditions.


Finally, it remains to observe the palpable similarities between Harry and the patron of this award. Dr Pask was another who was prepared to push boundaries and take personal risks in pursuit of scientific truth and better outcomes for all. There no doubt he would be proud to see his eponymous award go to Dr Richard Harris.


Professor Simon Mitchell
Head of The Department of Anaesthesiology
University of Auckland, New Zealand

Somehow, a mere "like" seems insufficient. Outstanding! The people on that team are my heroes.

 

[Jay]

I want to tell a story that is related to this thread: I remember being at work and people were coming to me as a diver and anesthesiologist asking me a multitude of questions on many aspects of diving in caves. Some questions were rudimentary some more complex. I remember being on edge for a few days as many thoughts came to my mind as how to rescue these kids and their coach while keeping the rescuers safe as well.

I remember telling people that panic in the kids will lead to almost certain drowning. My colleagues were joking about providing sedation in dive situation saying if we could only sedate the children underwater. Deep in thought I told them their are only a few drugs that will work; 2 drugs came to mind: ketamine and dexmedetomidine. Both have different cardiovascular side effects and mechanism of action is different. However the common thread is that the patient (and the divers) will maintain spontaneous ventilation if the correct amount of drug was used.

To my surprise, I found later that at least one of these drugs were used in the rescue. I was in cloud nine not because they did what I thought would work but because the kids were saved. Even today, I marvel at the rescue of these children and their coach with minimal loss of life. I think it will go in the history books as one of the greatest rescues in history. I still marvel at the bravery of the rescuers. As you may know, one of the rescuers was an anesthesiologist. Kudos to him and the other uber brave rescuers.

I remembered sharing a 'random thought' in the earlier thread about anaesthetising them and using a FFM but someone told me it wasn't very practical and high risk. That was on the second day after they were located and the first day of their diving lessons. Now I know the difference between anesthesia and sedation Sedation and General Anesthesia: What’s the Difference?

 

[Schwob]

a New / updated / reminiscing article from today:
Achieving the impossible: Thai cave rescue a year on

Achieving the impossible: Thai cave rescue a year on

The Netflix special is available July 1st.

 

[Schwob]

In error

 

[Dr Simon Mitchell]

Hello,

We are now very close to publishing the first full account of the medical / diving management of the children and coach in the rescue. It will come out in the June 30 issue of Diving and Hyperbaric Medicine, and has been earmarked for immediate release on Pubmed Central - meaning everyone will be able to download it the day it is released. I will come back on here and point out the link. The paper also contains an evaluation of the full face mask used on the children, and its particular qualities that almost certainly contributed to the success of the rescue.

van Waart H, Harris RJ, Gant N, Vrijdag X, Challen CJ, Lawthaweesawat C, Mitchell SJ. Deep anaesthesia: the Thailand cave rescue and its implications for management of the unconscious diver underwater. Diving Hyperb Med. 2020;50(2): In press.

In February I had the pleasure of spending two weeks with Richard Harris and Craig Challen (a vet who also played a crucial role in managing the boys) diving a cave in New Zealand's south island. They pushed it to 245m depth in a 16 hour dive in 6 degree water! I have uploaded a photo of the team with Challen (left) and Harris (right) in their puffy jackets. Also the vertical shaft that goes straight down to 110m showing the 30m (close) and 40m (distant) habitats we put in there.

Simon

 

[Gareth J]

I am in awe of the divers involved in this rescue. As others have said, they where supported by a huge number of volunteers, from those that provided medical support to those that cooked and cleaned. All deserve our respect.

One issue I heard which may not be true. Is whilst the Australian diplomatics went to great lengths to ensure their citizens where protected from prosecution if the rescue was unsuccessful. The UK foreign office made no such efforts, which as a British citizen is extremely worrying.

 

[Wathdoc]

I am in awe of the divers involved in this rescue. As others have said, they where supported by a huge number of volunteers, from those that provided medical support to those that cooked and cleaned. All deserve our respect.

One issue I heard which may not be true. Is whilst the Australian diplomatics went to great lengths to ensure their citizens where protected from prosecution if the rescue was unsuccessful. The UK foreign office made no such efforts, which as a British citizen is extremely worrying.

I understood that the British divers did not ask for it. It was principally because the Australian was the one who was going to anaesthetise the children and be at greater risk of being sued.