PADI and SDI Rescue Scenerio differences

[boulderjohn]

If you are worried about doing the exact right thing in this circumstance....

I have many, many times issued this challenge: identify a case in which divers have come across an unresponsive diver underwater, brought the victim to the surface, called for help, begun rescue breaths, towed the diver to shore or boat while giving rescue breaths, removed the divers gear while giving rescue breaths, removed the rescuer's gear while giving rescue breaths, brought the diver to a hard surface, begun CPR, and had the victim survive.

I am still awaiting my first successful scenario.

 

[Bubblesong]

@boulderjohn true, but it helps alleviate apprehension to anticipate the worst and think I can do something about it. This fantasy of invincibility does get astonishingly unrealistic, but at least I don't lose too much sleep.
"Beyond this place of wrath and tears Looms but the Horror of the shade, And yet the menace of the years Finds, and shall find, me unafraid. It matters not how strait the gate, How charged with punishments the scroll, I am the master of my fate: I am the captain of mysoul."

 

[Kevrumbo]

If you are worried about doing the exact right thing in this circumstance....

I have many, many times issued this challenge: identify a case in which divers have come across an unresponsive diver underwater, brought the victim to the surface, called for help, begun rescue breaths, towed the diver to shore or boat while giving rescue breaths, removed the divers gear while giving rescue breaths, removed the rescuer's gear while giving rescue breaths, brought the diver to a hard surface, begun CPR, and had the victim survive.

I am still awaiting my first successful scenario.

The prognosis is usually critical to grave if a dive accident victim arrives at a Emergency Dept/Hyperbaric Facility without a pulse.

However:
There is one Full Arrest case history that is frequently cited in USC's/Catalina Dive Emergency Response and Management Courses, that prior to arrival at the Catalina Hyperbaric Chamber for a Table 6A AGE Treatment, the patient was defibrillated five times in the 62min it took Lifeguard Paramedics to transport the casualty to the Chamber, and who miraculously walked out of the hospital two weeks later with no residual problems. The victim experienced a rapid ascent to the surface and lost consciousness at the surface (Avalon Underwater Park at Casino Point, Catalina Island).

Also:

. . .We cited one published case of a diver who was sent buoyant, unconscious and alone to the surface from 70m and who survived. We also cited an unpublished case of a rescuer who allegedly successfully managed a breathing diver's airway for a short period to complete decompression. . .

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@boulderjohn true, but it helps alleviate apprehension to anticipate the worst and think I can do something about it. This fantasy of invincibility does get astonishingly unrealistic, but at least I don't lose too much sleep.
"Beyond this place of wrath and tears Looms but the Horror of the shade, And yet the menace of the years Finds, and shall find, me unafraid. It matters not how strait the gate, How charged with punishments the scroll, I am the master of my fate: I am the captain of mysoul."

Do the absolute best you can as trained until relieved, or you cannot physically continue -or a physician declares the victim as deceased.

 

[wetb4igetinthewater]

1. In PADI rescue course, I was taught that after discoving an unresponsive diver, signaling/trying to get their attention, and turning them over...the first thing done is to establish their buoyancy, then mine. Next was to call for help, then remove weights/mask/reg...

When I did my IDC (December of 2015), it was "diver, diver, are you okay? You in the yellow hat, call 911" while splashing towards them and upon reaching them inflating their BCD and then flip the unresponsive diver at the surface over establishing buoyancy.

 

[Dr Simon Mitchell]

Hello all.I am here once again to tap into the vast knowledge of the members here to answer a question I have.

Hello,

To be honest I would not get too anxious about the order in which those things are done. If you manage to do them all at all with any semblance of quality you will be doing well. As for what buoyancy you do or don't establish and what you remove or don't remove, the only sensible (and pragmatic) answer is you do what you need to do to make the situation work for you. The end game if the diver is not breathing and you can't remove them from the water immediately is to engineer a situation where you can deliver some rescue breaths whilst still in the water.

CPR has evolved into only doing compressions in one man CPR-no breaths every 15 compressions like it used to be.

This is true for community cardiac arrest on dry land, but it is not correct for drowning (which is what we must assume we are dealing with in a diver). The reasons are detailed in the UHMS Rescue Guideline paper which I have uploaded to this post.

Simon M

 

[Schwob]

My thigh is almost big enough to get a tattoo of that diagram for easy reference in case I need to refer to it in an emergency.
As it is, I will just have to keep practicing drills during safety stops if my buddy will cooperate.

Have you heart of the unconscious, unresponsive diver who during the tow to land, maybe due to the rescue breath came, unnoticed so, into a state of semi consciousness? Then on land while he was thinking he was watching his rescue angel strip out of her wetsuit and intently stare at her own thigh (to have the diagram guide her into what next) completely woke up just because he just had to figure out WTH is going on?
Yeah, me neither. But that thigh thing is a funny picture...

 

[boulderjohn]

The prognosis is usually critical to grave if a dive accident victim arrives at a Emergency Dept/Hyperbaric Facility without a pulse.

However:
There is one Full Arrest case history that is frequently cited in USC's/Catalina Dive Emergency Response and Management Courses, that prior to arrival at the Catalina Hyperbaric Chamber for a Table 6A AGE Treatment, the patient was defibrillated five times in the 62min it took Lifeguard Paramedics to transport the casualty to the Chamber, and who miraculously walked out of the hospital two weeks later with no residual problems. The victim experienced a rapid ascent to the surface and lost consciousness at the surface (Avalon Underwater Park at Casino Point, Catalina Island).

Also:

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Do the absolute best you can as trained until relieved, or you cannot physically continue -or a physician declares the victim as deceased.

As happens every time I made the challenge for people to give me an example of the scenario I describe, I get deluged with examples of cases different from the one I described. It's as if I were to say there has never been a case of a purely purple cow, and then people send me picture after picture of black and white cows to prove I am wrong.

 

[Colliam7]

1. In PADI rescue course, I was taught that after discoving an unresponsive diver, signaling/trying to get their attention, and turning them over...the first thing done is to establish their buoyancy, then mine. Next was to call for help, then remove weights/mask/reg...10 seconds check, then begin rescue breaths

In my SDI DM review of the same thing, I was told that after turning the unconscious diver over, to forgo establishing more buoyancy for the victim or myself, to remove weights/mask reg...then 10 seconds check...and if not breathing to THEN signal or call for help, following by ther rescue breaths. I wonder what the reasoning is for the difference of WHEN the call for help is made?

2. On the same token...in my PADI rescue course, I was taught that after the first 2 initial rescue breaths...each following breath should come every 5 seconds. With SDI..it was every 10 seconds. IM not sure if that difference has any real advantage to the heath of the victim, or otherwise allows more time between breaths for a faster equipment removal and movement to the boat/shore...but as in line with number 1...i would love to hear others opinions about why that is done.

I am PADI 'born and bred', and won't try to answer for WHY SDI procedures may differ. Rather I can try to suggest some of the reasoning behind PADI procedures.

For the first question: the idea of calling for help early is that with an unresponsive diver - whether they are breathing or not - you are in all likelihood going to need help - possibly before getting them to shore, then to get them out of the water, and then EMS support to assess their condition, even if it is only unresponsiveness. So, call for it (early, maybe even often, like voting ). You don't lose time by calling for it early.

For the second question, I have an impression but cannot state that it is accurate. I was an AHA CPR Instructor-Trainer for many years, in the mid-70s to mid-80s. During that period based on the (frankly, very limited) available data, the mindset was that we needed to support respiration as well as cardiac function. I have a sense the PADI technique - breathe every 5 seconds - grew out of those 'mature' procedures and there has really not been a sound basis for changing. Over the ensuing decades, with each revision of the guidelines, we have moved away from respiratory support toward much more vigorous cardiac support, ON LAND. Unfortunately, we cannot offer the same cardiac support in water (at least not yet).

One additional thought: boulderjohn makes a slightly cynical, but very valid point (and i share his cynicism). Resuscitation rates on land are at best 'mediocre' That is not a criticism, just a statement of the reality of cardiopulmonary arrest. But, we will still do everything we can in the faint hope that function can be restored, or that we can somehow keep the patient 'viable' until multi-function EMS support become available. In water the results are no longer 'mediocre', they are frankly very poor. I think an argument could be made that the one best thing we can do for the unresponsive, non-breathing diver, is get him/her out of the water ASAP, and forget everything after establishing that they are unresponsive.

 

[Kevrumbo]

As happens every time I made the challenge for people to give me an example of the scenario I describe, I get deluged with examples of cases different from the one I described. It's as if I were to say there has never been a case of a purely purple cow, and then people send me picture after picture of black and white cows to prove I am wrong.

No John. You just need to go where there are a lot of potential "cows" of all sorts and see for yourself. . .

Full arrest Rule-Out AGE, Rule-Out near Drowning with survival and full recovery two weeks later. (See minute 4:28 in video below where Karl Huggins also mentions this case in passing).

If you really want to study the private case histories, or perhaps having the best chance to see a real world scenario like you describe @boulderjohn , you should take the training class here and then volunteer to work Chamber Crew on the opening night of Lobster Season. . .

The basic rescue technique that PADI teaches is the important BLS (Basic Life Support) core action of every trained non-professional recreational Rescue Diver, and professional first responder Dive Master and Diveboat Captain & Crew here in offshore Southern California, and the start of the vital chain of ACLS (Advanced Cardiac Life Support) for dive accident victims of which LA County Lifeguard-Paramedics, US Coast Guard and the USC Catalina Hyperbaric Chamber has been providing for over the past 40 years. . .

 

[Dr Simon Mitchell]

Over the ensuing decades, with each revision of the guidelines, we have moved away from respiratory support toward much more vigorous cardiac support, ON LAND. Unfortunately, we cannot offer the same cardiac support in water (at least not yet).

Hello Colliam,

This reflects a very common misunderstanding about the differences between community cardiac arrest and what happens in drowning.

The reason we would not recommend compression only CPR in water is nothing to do with an inability to offer cardiac support in the water. Even if we could do effective cardiac support / chest compressions in water we would not recommend compression only CPR where asphyxia is the likely cause of respiratory / cardiac arrest.

Compression only CPR is effective in community cardiac arrest because the cardiac arrhythmia / arrest is the cause of cessation of breathing. At the point of ceasing breathing the patient is oxygenated and importantly there is oxygen in the lungs. Compression only CPR works because it will circulate blood, and some oxygenation of that blood will occur as it passes through the lungs.

In asphyxia / drowning the patient becomes hypoxic before the cardiac arrest; indeed, hypoxia is the eventual cause of the cardiac arrest. That is, as hypoxia worsens, breathing efforts cease and eventually, if the hypoxia is not corrected, there will also be a cardiac arrest. Compression only CPR will not work in this setting because there is effectively no oxygen to circulate. It is even worse than that though. As implied, there is a period between respiratory and cardiac arrest. If hypoxia can be corrected during this period then cardiac arrest may be prevented which, in reality, is the only thing likely to save a life out in the ocean. In a diving rescue it is not possible to tell if the victim is in respiratory but not cardiac arrest, but if that is the situation (and we would hope it is), then the only realistic chance of saving the victim is to stop them going into cardiac arrest in the first place. Thus, rescue breaths (breaths as early as it is physically possible to administer them) may be the key life saving intervention in drowning.

This is all detailed in the paper I uploaded to my previous post, and in the latest iteration of the European Resuscitation Council Guidelines which are cited in that paper.

Simon M