ascending with unconscious victim

[The Chairman]

I have never seen an OxTox victim, so I can not give an eye witness account. I have experienced some of the symptoms (esp. perceptual narrowing) and can describe those in detail. I have seen a friend go into a seizure, and a car accident victim go into convulsions. I don't think that it would be hard to distinguish an unconscious diver from a convulsing one. One would be still; the other would be at least twitching somewhat. The original scenario was for an unconscious diver, not a convulsing one.

However, if the convulsing diver became so completely catatonic so as to simulate an unconscious diver HOW would you tell the difference? I say you couldn't, and that the law of averages would necessitate me to assume drowning (common) and not OxTox (uncommon). Assuming the former, the course of action would be to ascend as quickly as is prudent and initiate rescue breathing and CPR once on the surface. Personally, I would use ALERT, but you should use what YOU are comfortable with.

Now let’s step away from the unconscious diver and back to the OxTox protocol… IF a convulsing diver still has a reg in his mouth it should remain there and be held in. If it is out, then your reg may go in (depending on your mix). A convulsing diver should not ascend appreciably until the convulsion stops. Breathing should be present and ascent should be slow but directly to the surface, UNLESS convulsions start again. Then you wait out the convulsions and ascend when they subside. If the diver should be rendered unconscious during this period, then a quick ascent would be warranted.

Combining the two scenarios is needlessly confusing. So let’s talk one or the other.

 

[Hallmac]

Genesis once bubbled...



If he is tonic, then his airway is locked shut. If you take him up before he comes out of that, you will cause pulmonary barotrauma


3. You have no way to know if he has toxed or not, EXCEPT to wait approximately one minute (the maximum he could reasonably be expected to stay in a tonic state post-hit) before ascending.

You wouldn't know. If he has toxed he will not be breathing until the tonic phase passes. If you take him up even 5-10' and he has toxed, and is tonic, you will kill him. If you do not give him a reg with good gas in it before he starts breathing again, you will kill him.

If he is NOT toxing, he's probably already dead, no?

The question is "how do the probabilities work here"? You have no way to know, unless you WITNESS the event that causes the diver to go unconscious, WHY it happened. You can only guess at how long ago AND why. But if "how long ago" is anything over 2 minutes, he's gone - it will be 2 more, assuming 60' or so of depth, before you can get CPR started, and the "hard line" is at 4 minutes post-event.

Yes?

The above quote was edited

I would offer this in response. If he is stiff he is Tonic if the body is limp the tonic phase has passed. You don't have to have witnessed the event to tell.
Second please don't take the four minute rule as fact! Depending on several factors not mentioned here there have been many saves hours after the fact.

Hallmac

 

[Genesis]

Depending on several factors not mentioned here there have been many saves hours after the fact.

Yes, in extraordinarily cold water or other extreme cases, it is possible. Mamilian diving reflex and all that, along with the physiological reactions to extreme cold-shock.

None of which is likely to apply to a diver, who is wearing exposure protection to prevent this from happening.

Now "4 minutes" is not a hard and fast rule, no. Sure, there are outliers in any event.

But somewhere along the line you have to come back to basic principles:

1. Killing yourself (or getting close to it - e.g. giving youself an AGE or Type II DCS hit) trying to rescue a corpse is a bad deal all the way around.
2. Extreme high-speed ascents, or doing things that could lead to them, make (1) quite possible.
3. If a diver is found, not breathing, on the bottom, where you did not witness the event precipitating the loss of consciousness, the odds are overwhelming that he or she has expired. Temperance in rescue efforts seem to be warranted, given this fact and (1) above. Dumping the victim's weight belt is probably not a good option as that almost certainly makes your effort a body recovery (whether it was before or not); you want to be surfacing WITH the victim so you can render CPR as soon as you arrive at the surface.
4. If you have reason to believe a tox hit may be involved, for any reason, eliminating that possibility (or guarding against killing a diver who may have toxed but is otherwise alive) seems to be prudent. Checking to see if the victim is limp or rigid might be a valid way of doing this (does that jive?)
5. Insuring that a regulator is in the victim's mouth with a known safe breathable gas mix (yours!) can't hurt and might help. Even if there is no reg in there when you find him, if he's gonna spasm from inhaling water, or already has, or has managed to fill his lungs with water, he is or has. You can't change THAT, but you can insure that there is gas available if/when he begins respiring again on the way up. Unlikely to help in most cases, but it won't hurt him.
6. If a diver IS breathing, then (1) you can remove him to the surface at a reasonable rate of ascent, (2) the rescue effort IS worthwhile (since he's not already dead!) and (3) more risk to your person to effectuate a rescue may be warranted, since you know the victim is currently alive. However, some consideration to surface support probably has to come into this reasoning if you don't know how long he has been down (and how much deco obligation he may have accumulated, if any.) Is bending the victim if he has exceeded the NDL (assume you find no computer on his person, so no instant way to know if he is within the NDLs or not) reasonable? I'd say "probably", given the alternative.

Make sense as a set of starting points?

 

[Diver0001]

NetDoc once bubbled...


<snip>

Diver0001... who ever said to let them go up alone??? Re-read my first post.

<snip> .

I think you lost me Pete. When you said in your first post

Equipment... dis-entangle (if needed) and remove weights (belts or pockets) COMPLETELY from the diver. Hold them at arms length to avoid fouling and drop. Victim should now be bouyant.

It made me think you were saying to dump the weights at depth. He'll be buyouant alright.....and you won't have any control over the ascent if you do that. Weights get dropped on the surface after the CBL. Are we on the same page?

R..

 

[The Chairman]

I have demonstrated this at least a hundred times with all the divers in wet suits and weighted accordingly (it's a part of NAUI's OW training). I have YET to have a "runaway" victim. I don't believe your fears about releasing weights at depth are warranted or established in fact and reality. In fact, I always end up having to help the ascent. You can slow ascent if needed in several ways, including the attitude of the victim as they rise in the water.

The possibility of AGE, embolism or other barotrauma is eclipsed by the reality of drowning. Even for the rescuer, the incidence of these events is still so rare as to merit the immediate extraction of an unconscious diver from depth.

 

[MikeFerrara]

NetDoc once bubbled...
I have demonstrated this at least a hundred times with all the divers in wet suits and weighted accordingly (it's a part of NAUI's OW training). I have YET to have a "runaway" victim. I don't believe your fears about releasing weights at depth are warranted or established in fact and reality. In fact, I always end up having to help the ascent. You can slow ascent if needed in several ways, including the attitude of the victim as they rise in the water.

The possibility of AGE, embolism or other barotrauma is eclipsed by the reality of drowning. Even for the rescuer, the incidence of these events is still so rare as to merit the immediate extraction of an unconscious diver from depth.

What kind of wet suit do you use for this. I don't think I could control the ascent of a person wearing a 2 piece 7 mil suit.

I don't think the drowning eclipses the chance of AGE because when you get them to the surface they might not have lungs to blow air into. You can bring them up without droping their weights anyway so why risk losing control?

There may be situations where droping some weight at depth would be required like if they had a flooded dry suit and were very heavy but I would never dump more than I had to to be able to lift them.

 

[The Chairman]

are 3 mil. Obviously, your response would be mitigated by your locale. This works for the MOST of the areas I and my students would be diving in.

That would not only be covered by the "look" portion, but also by situational awareness.

 

[MikeS]

NetDoc,

You seem to keep evading the question, but let’s try one more time.

Why would you drop the weights? What is the advantage of this over simply adding air to their BC to make them neutrally buoyant? There is a clear advantage to simply adding air when it comes to controlling buoyancy and hence rate of ascent. Even if they’re out of air, every OW diver should be able to orally inflate their BC.

NetDoc once bubbled...
are 3 mil. Obviously, your response would be mitigated by your locale. This works for the MOST of the areas I and my students would be diving in.

IMO this is a shortsighted approach unless you are going to issue 3 mil or less C-cards.

NetDoc once bubbled...
The BEST rescuer sees the problem before it happens.

The BEST rescue is one that never has to happen.

The BEST rescuer can think in his fins and adapts to changes easily.

Stop obfuscating and answer the question.

Mike

 

[The Chairman]

would be an OOA situation. Consequently there is noo air in tank to inflate the BC. IF the diver is on the bottom then he is negative... if I start farting with the air on the BC, I will probably overcompensate and thus MAGNIFY the effects from Boyles' law.

Now, I teach divers to LOOK first act second. You must assess the diving environment (before you even get in) and the current situation you find yourself in. You should re-evaluate as you proceed. In the OW areas of Florida, weights are the best thing to lose first.

Now answer me this... how fast would a diver who lost his weights ascend?

 

[The Chairman]

MikeS... I have not evaded any question. You just don't like my answers. Lets not turn this into a personal thing, OK? You don't accuse me of obfuscating anything, and I won't call you a poopy head. Is that cool? Lets just keep this respectful of all involved.