Is it ( FINALLY! ) time for a change in protocol?

[DeepSeaDan]

It looks like more study really is in order in specific regards to drowning and near drowning incidents. There is emphasis in an instructor newsletter I received on artificial ventilations and how over inflating a victim's chest can impair blood flow from the thoracic (sp?) area. Hopefully there will be a more definitive answer soon and then all the different training agencies, not just SCUBA will have to revamp their training doctrine as well as support materials.

1. Witnessed drowning with quick ( :5 or less ) patient recovery:

> surface casualty, protecting the airway as best as possible, attempt several rescue breaths. Response? If no response, tow as-fast-as-possible to boat / shore for cpr / O2 /defib. etc.

2. Recovery of non-breathing diver from depth ( casualty time on bottom >:5; if unsure, try several rescue breaths first, upon surfacing ):

> surface casualty protecting the airway as best as possible, make for boat / shore a.f.a.p., start cpr / O2 / Defib. etc.

IMO, thats what we need to teach. Simple, easy to remember & logical.

DSD

 

[TSandM]

DeepSeaDan, I completely agree with you and I have written this a number of times here. After my rescue course, I was very unimpressed with the probability of doing effective artificial respiration in the water, and I continue to suspect that a diver who does not respond to two rescue breaths with some attempt at spontaneous respiration is probably in circulatory arrest as well, where artificial respiration is useless.

 

[CBulla]

...that there is still too much emphasis on teaching in-water rescue breathing ( specifically while towing ). PADI has taken the step of given the rescuer an option ( the :5 distance rule ), but I don't think that goes far enough ( & I think they actually have it backwards! ). The bottom line is that in most instances, the casualty needs circulating blood, & the best way ( & the only way, as you've indicated ) is to get them to a flat, hard surface at all possible speed.

DSD

Right on! Without the heart circulating the blood, the breaths are doing nothing more than testing the endurance of the in water rescuer.

 

[ReefHound]

Right on! Without the heart circulating the blood, the breaths are doing nothing more than testing the endurance of the in water rescuer.

That's true but I think the logic behind the rescue breaths is that it can be difficult to ascertain if there is circulation or not. A person could have a very weak pulse. Getting out is paramount but you should be able to provide rescue breaths over a short distance without significantly slowing that process. But as always the rescuer has to make judgment calls and improvisations based on the situation. If they are winded, if they cannot deliver effective breaths, if they cannot maintain forward momentum, if they are far from shore, then getting out of the water remains the primary objective.

 

[DeepSeaDan]

That's true but I think the logic behind the rescue breaths is that it can be difficult to ascertain if there is circulation or not. A person could have a very weak pulse. Getting out is paramount but you should be able to provide rescue breaths over a short distance without significantly slowing that process. But as always the rescuer has to make judgment calls and improvisations based on the situation. If they are winded, if they cannot deliver effective breaths, if they cannot maintain forward momentum, if they are far from shore, then getting out of the water remains the primary objective.

...is now looking for "signs of circulation" ( normal colour, normal breathing movement ) - the carotid pulse check is no longer mandatory ( we in the Red Cross are not obliged to teach it any longer ). These new criteria make it simpler to assess circulation in the water.

Fact is, if they don't respond to the initial rescue breaths, they are unlikely to spontaneously re-vitalize with continued attempts at ventillation ( no matter how many times I ask, no one has ever said they think they can deliver effective rescue breathing in average open water conditions - I think people like to keep their head in the sand on this issue. ).

The physicians I've spoke to ( TS & M, jump in on this would you? ) generally agree that the heart will cease to create a perfusing rythm one to several minutes after cessation of breathing. That does not give the rescuer much time to intervene.

I'll keep pounding away at this. We've been doing it for so long in the familiar way that resistance to change is expected. Hopefully the data from the field combined with continuing research will lead to positive change, sooner rather than later.

Regards,
DSD

 

[TSandM]

I suppose it is vaguely conceivable that you could have a person with a faint pulse who wasn't breathing. But why the faint pulse? If somebody has had a massive MI in the water, they're in deep trouble. If they haven't and they've drowned or been oxygen-starved, then a couple of breaths will restart their respiration (or at least produce a cough) OR they are very severely depressed neurologically -- and that's either bad anoxic injury or hypoperfusion.

Given what I saw in Rescue, and what I was able to do, and what I know about attempts at artificial respiration ON LAND, I have made my own personal decision. Two breaths; no response at all, tow like crazy and hope against hope.

 

[DeepSeaDan]

Given what I saw in Rescue, and what I was able to do, and what I know about attempts at artificial respiration ON LAND, I have made my own personal decision. Two breaths; no response at all, tow like crazy and hope against hope.

I just hope your there when I have the big one Doc; but please, be sure I'm "out" before the catheter goes "in" :shakehead ...deal?

Regards,
DSD

 

[mtg]

"Dr. Robert Harner, a Rockford cardiologist, and Dr. John Underwood, SwedishAmerican Hospital’s emergency medical director, prompted a 13-month study of the method with the Rockford and Byron fire departments. By using only continuous chest compression and automatic external defibrillators, they found that 28 percent of heart attack victims lived and 82 percent of those survivors suffered little or no ill effects to brain function. Under normal CPR protocol, which also uses AEDs, the local medical community saved only about 3.7 percent of its heart attack victims, a standard survival rate, said Bob Vertiz, training coordinator for emergency medical services at the Rockford Fire Department"

About the crappiest study protocol I can imagine, how many of each? what amount of time before help arrived?

if AEDs where so insignificant to the survival rate with standard CPR, why was the push to have them in public spaces successful? after all they aren't cheap...

as to the rest of it - it makes sense and a well designed study should be implemented.

 

[HammerNoMore]

Effectiveness of rescue breaths not withstanding, I'm confused as to why you think you cannot give a proper rescue breath inwater?

 

[TSandM]

Getting a good seal, either with mouth-to-mouth or with a mask, is not simple. I have seen trained emergency personnel failing to deliver effective breaths with ideal equipment. When you have two divers in the water, with the awkwardness and instability of both, getting positioned and stable enough to give really effective ventilation is, in my opinion, not something you can do really fast -- The mimed rescues where we just reared up over the person and pretended are great, but in practice, I'm quite sure it would be more difficult than that. The end result is that you either don't ventilate much or your towing is slowed to where you're not making much progress at all. Towing another diver isn't particularly fast, anyway -- and no matter what you think about rescue breathing in water, you have to admit that truly effective resuscitation is going to be much better done on land.

Frankly, the situation of an unconscious victim with no spontaneous respirations any distance from the shore/boat is a very bad one, no matter what anybody does.