Rescue course ( PADI ) in SM ?

[Jim Lapenta]

The last rescue class I taught there were two students in sidemount. One in back mount doubles. I alternated between SM and back mount single. Including the one weekend certed diver who put his gear together via youtube . That was the rig I used to get "trapped" on the bottom in and they not only had to bring me up but actually cut me out of the harness.
This was not a PADI class so the rescue breathing while towing was discussed and demonstrated, but it was noted that it's optional and getting the victim out of the water onto a stable platform is more important.
Under the new CPR guidelines that emphasize compressions , and the fact that the average rescue diver is unlikely to practice the skill enough to actually be able to do it effectively in a real rescue when the stress is on and adrenalin pumping, delivering effective breaths is problematic at best. What it is more likely to do is delay effective treatment and ensure brain damage.
With sidemount, you don't worry about the gear on the victim. Dump the tanks and regs. Cut the BC off once you are close enough to shore that you don't need it for flotation. If you are the rescuer there are effective ways to tow if you don't want to dump your gear. However in an actual rescue what's worth more, your tanks and regs or the life of the victim?

 

[tursiops]

Under the new CPR guidelines that emphasize compressions , and the fact that the average rescue diver is unlikely to practice the skill enough to actually be able to do it effectively in a real rescue when the stress is on and adrenalin pumping, delivering effective breaths is problematic at best. What it is more likely to do is delay effective treatment and ensure brain damage.

The new CPR guidelines are NOT applicable in cases of downing or O2 depletion. The assumption that underlies hands-only CPR is that there is still oxygen in the system and it just needs to be pumped around. Best to practice rescue breaths.

 

[Jim Lapenta]

Oh we practice it in the class. Then I show them the difference in time between doing them and getting the victim to a stable platform where they are more or less guaranteed that effective breaths can be delivered. So far a physician's assistant, combat medic, pharmacist, and wilderness rescue person all said if they are ever the vic they hope that someone who took a rescue class a year ago and has not practiced in-water breaths since doesn't try to waste time doing them.

 

[tursiops]

Oh we practice it in the class. Then I show them the difference in time between doing them and getting the victim to a stable platform where they are more or less guaranteed that effective breaths can be delivered. So far a physician's assistant, combat medic, pharmacist, and wilderness rescue person all said if they are ever the vic they hope that someone who took a rescue class a year ago and has not practiced in-water breaths since doesn't try to waste time doing them.

Right. I'm not saying ignoring breaths is a bad idea, I'm saying that ignoring them in our situation is NOT part of the new guidelines.

 

[SeaHorse81]

Oh we practice it in the class. Then I show them the difference in time between doing them and getting the victim to a stable platform where they are more or less guaranteed that effective breaths can be delivered. So far a physician's assistant, combat medic, pharmacist, and wilderness rescue person all said if they are ever the vic they hope that someone who took a rescue class a year ago and has not practiced in-water breaths since doesn't try to waste time doing them.

Having done that drill myself and witnessed numerous others doing the same, I have to say the time penalty associated with attempting rescue breaths in the water on the way to boat or shore is astounding. For in-water rescue, it just doesn't seem beneficial at all. If I'm a victim, I'll add my vote to the "just get me there as fast as possible" camp.

 

[tursiops]

When PADI revised the Rescue class back in 2004-2005, the new instructional materials – including the slates – had a discussion on “inwater resuscitation” that was about whether to ventilate or not while towing. They published a clarification in the 3rdQ/2005 Training Bulletin:

“The Inwater Resuscitation Guidelines found in the Appendix of the PADI Rescue Diver Course Instructor Guide provide a course of action for divers attending to a nonbreathing diver in the water. Based on current research (as noted at the end of the guidelines) it maps out eight steps to consider when handling this type of emergency. The last step reinforces the need to evaluate the specific circumstances and make decisions accordingly — specifically, whether you are more or less than five minutes from the shore or boat, and whether the victim is responding to rescue breaths. To clarify this guideline, if you determine that you are more than five minutes from the shore or boat, you need to evaluate whether the victim has any movement or other reactions to ventilations. If the victim shows some response to ventilations, but doesn’t completely resume self-sufficient breathing, it still indicates that ventilations are having a positive effect. You should continue to ventilate during the tow because the person may be able to regain breathing control through your efforts. It is inferred that if the person regains complete breathing control, you should discontinue ventilations but continue to monitor the diver during the tow.”

The PADI Rescue course does NOT mandate ventilations while towing, but it does require (as a standard) that you demonstrate you can do it. Whether you actually do it or not in real life is a judgement call, because in some situations (respiratory arrrest but not cardiac arrest) it gives the victim a better chance at survival. and that is really the goal, isn't it?

 

[tursiops]

further, the 4Q/2016 Training Bulletin says:
"Q. Emergency First Response® (EFR®) courses mention that if for some reason an emergency
responder can’t or won’t provide rescue breaths in a real emergency requiring CPR, giving compressions alone may still help. How does that relate to CPR given for drowning victims?
A. Giving rescue breaths is emphasized for drowning victims. Because lack of breathing due to drowning is often suspected in dive accidents, rescue breathing remains a key skill in diver rescue. The PADI Rescue Diver course teaches divers to provide inwater rescue breaths, and once on a stable platform, to start CPR – including both rescue breaths and compressions to aid a nonbreathing dive accident victim. In many countries, protocol for suspected drowning is immediate CPR if possible; giving breaths fi rst, followed by chest compressions. Following base ILCOR recommendations, in other countries the local ILCOR representatives emphasize the need for rescue breathing with suspected drowning, but do not specify starting CPR with breaths. Experts in the medical community don’t agree on how important giving breaths first is in drowning
cases, but virtually all agree that beginning CPR (breaths and compressions) as soon as possible is important. Giving chest compressions with rescue breaths continues to be the standard of care (best chance for successful outcome) for layperson CPR, which is why both skills are taught as a twostep CPR process in EFR courses. In any emergency with a nonbreathing patient, giving chest compressions alone is not ideal, but if for some reason the rescuer can’t, or has fears about giving rescue breaths, then giving chest compressions alone is still considered beneficial."

 

[Remy B.]

Going back to the OP, the way I see it, I believe it is more beneficial if the victim is in sidemount, as in a rescue I believe ( Not saying that I'm right ) you can un-clip the tanks and ditch after partially inflating the victims BCD at surface, that I guess will aid in the rescue at water surface, I don't know if you can swim faster dragging the victim this way.

I guess it can be very beneficial on high waves to have your victim floating with his own BCD and tanks out of the way, just speculating.

 

[Patoux01]

With sidemount, you don't worry about the gear on the victim. Dump the tanks and regs. Cut the BC off once you are close enough to shore that you don't need it for flotation.

Be very careful when cutting on sidemount rigs... If you cut mine like an idiot, I'll sink straight to the bottom of the ocean, which is sad. The weights are in the harness, which is under the BC, which is a separate item (Stealth 2.0). So if you cut the BC, bye bye.


As for more difficult with sidemount, surely if you have 2 tanks instead of 1. But remember that sidemount can be done with a single tank as well....

 

[DevonDiver]

For in-water rescue, it just doesn't seem beneficial at all. If I'm a victim, I'll add my vote to the "just get me there as fast as possible" camp.

If the victim isn't breathing, then a few minutes towing means you're just going to deliver a corpse to the boat/shore.

If you can get the victim onto a solid surface (boat/shore) within a few minutes of respiration ceasing, then the rapid initiation of full CPR is their best chance of survival.

Bear in mind that those "few minutes" incudes raising the victim, stabilising and assessing them at the surface, towing them AND getting them out of the water.

3-4 minutes and brain damage is likely. 5+ minutes and death is probable.

When I did an unresponsive diver rescue for real, the incident happened just below the surface. The diver was in distress but reached the surface on his own. He was very large and panicking. Before I could maneuver him and drop his weights, his head sank momentarily below the surface, where he inhaled water and became near-instantly unconscious.

At the time, we were located less than 10m from a slipway at the shore. I elected to immediately get him onto the slipway. I believe it took only seconds. Adrenalin must have assisted me 'one-arming' a very large man in full scuba kit up onto the slipway in a single lunge.

Once on the slipway, I had assistance de-kitting the victim, who was not breathing. Full CPR was initiated. Shortly after, a 'sternum rub' was applied. The victim had recovered breathing, but remained unconscious. He was air-lifted to hospital within 15 minutes and survived.

My incident was quite clear cut. We were very close to a shore exit and the victim had become unresponsive/ceased respiration just as the rescue was being initiated.

As soon as scenarios become less clear cut, the need for rescue breathing becomes much more pressing. Lifting, towing and exiting the diver TAKES time.

PADI say 'reach the boat or shore'.... and that's NOT correct. Because extracting a victim from the water can be timely. The time limit MUST apply to when full CPR can be properly initiated.

I find that sidemount harnesses (most types) make handling and lifting the victim easier. You are given lifting points.

Likewise, having that buoyancy in place during tows and rescue breathing in-water is a real benefit. I see so many students struggling to keep airways dry when the victim is dekitted to a wetsuit alone.

Yes, the weights are still en-situ... but the victim is more than adequately buoyant at the surface.

In cold water, there are other variables. The weight on the harness may be considerably heavier, which can hamper recovering the victim out of the water. Also, the victim may be wearing a drysuit. That favors de-kitting from the harness IF weights cannot be ditched. If weights could be ditched, I think leaving the harness in place is still favourable for the water extraction phase.