Rescue Course -- Should it be changed?

[raftingtigger]

When I took my latest Rescue class (2011) it was taught as knee-jerk responses. Start rescue breathing, strip the gear as you both tow and continue the breathing... I tried to inject some scenario into the training, such as not stripping the BC off if the diver isn't in an exposure suit (flotation), but was told to do it the same way regardless for the class.

I agree with the prior posters. A few rescue breaths to see if you can get a response, then get them as rapidly as possible to a place where more definitive care is possible. This may/may not mean stripping gear on the way. I also agree that trying to do rescue breaths, strip gear, and tow all at the same time is the least efficient method, but this might make a good experiment.

To make the students think more and consider differing conditions I would like to see different scenarios presented that require different responses. I.E. cold water, 200 yd swim, surf zone vs. warm water (no neoprene suit), 50 yd swim to boat. There may also be situations that require a second rescuer to help transition a surf zone without endangering the rescuer (Monastery beach on anything but a real calm day). Each rescue situation is different, yet right now we train a cookie cutter response.

---------- Post Merged at 12:42 PM ---------- Previous Post was at 12:37 PM ----------

My question about rescue breaths is this: can we use a regulators for rescue breaths? If you keep the mask on, airway open, reg in (after clearing ?) and purge the reg every few seconds. My favorite tow method is by the tank (like a tired diver) as I believe it to be one of the quickest. That would give easy access to the purge button, jaw to open the airway, and ability to keep their mask on. Especially when diving Nitrox. I mean, I know the exhaust valve mitigates a lot of the benefit...but it's still quite a bit of air pressure in their airways.

Doesn't work, the regulator exhaust valve opens before sufficient air goes into the lungs (probably none). If you succeed in blocking the exhaust valve, then you are likely to over-inflate the victims lungs and cause an air embolism. Try inflating your lungs sometime with an UNBLOCKED exhaust valve. I would never try it with a blocked exhaust valve.

 

[Jim Lapenta]

I did actually time my students in the rescue class. The difference between towing without rescue breaths and with averaged 4.5 times longer to get the vic out of the water where definitive breaths and chest compressions can take place. That time would likely mean the difference between brain dead and alive. And as many times as a DMC,DM, and instructor I have had my head shoved under water by someone trying to get in position to deliver and effective rescue breath on the first try has convinced me that only instructors, DM's, and those who practice the skill on a REGULAR basis should attempt it. Otherwise haul butt and get the vic to some help. And what some seem to be missing is that properly trained divers, diving as a buddy team are not likely to need to help each other. But the buddy team is very likely to come upon someone who was not as well trained, has not kept up on their skills, just may be a screw up, or for whatever reason ends up panicked. That is why I put as much if not more emphasis on effecting a rescue as a team as opposed to an individual doing it. In that case towing and stripping is a much easier task and rescue breathing may be a possible avenue of action. But even then if they don't practice it regularly getting the vic out of the water is the primary concern.

 

[Dive-aholic]

I never fully got the 'remove the equipment in the water concept.' I mean, I get that when you get them to the boat or what not you want to be able to easily lift them and get to what ever you need to get to but I always found the BCD to be helpful. In class, I was quick to drop their weight belt...but the BCD? Amazingly I never managed to get it fully off until that last big kick to the dock.

Try towing someone with full gear on and without. Then you might get it. The gear creates drag and slows you down a lot.

 

[haumana ronin]

Hmmm. For nearshore or a close boat: 2 or 3 breaths to make a possible drowning victim release a laryngospasm(which to my limited knowledge almost always occurs), then swim as fast as possible without endangering self towards nearest hard surface, stripping gear as you go, and begin CPR once you get there, breaths and compressions if willing, compressions only otherwise. Seems straight forward enough.

Why is stripping gear hard? If someone is on their back (in a vest BCD at least:tongue2 its clip, velcro, clip, clip, clip and everything falls away.

And since we are thinking outside of the cirriculum...
OK, now having lurked the recent and older cpr threads, having just gotten my fa/cpr cert, and some out of the box googling, how about this for a response:
Dont strip down the unconcious diver, inflate their BCD, blow hard across their face a few times while smacking lightly, give them two or three breaths, put their mask back on(being sure it seals well, if thats doable at all), put their reg back in, and ROLL THEM FACE DOWN, and then while holding the reg into make a good seal, drag them by the head as fast as you can. Make sure they have air in their tank. This might work if you are far from a hard surface as well.
:flame: away!

Maybe leave them face up and mask off but drape a sure-to-be soaked towel across their face.

:zen:

 

[t-mac]

Why is stripping gear hard? If someone is on their back (in a vest BCD at least:tongue2 its clip, velcro, clip, clip, clip and everything falls away.

Agreed, except that we are taught to tow, rescue-breathe and remove gear all at once. Three simple tasks when done in isolation, but very complex and inefficient when done together.

 

[DevonDiver]

I've 'de-stressed' the importance of in-water rescue breathing for a long time, for the reasons already outlined in this thread. Even assuming that the casualty 'just drowned before your eyes' and you got them up to the surface in seconds (rare and rare)... time is critical. In-water rescue breathing extends the time to full CPR by too much - significantly decreasing casualty survival.

On the one, true, non-breathing/drowned casualty I've had to rescue, I didn't bother with rescue breaths at all. Adrenalin was pumping (a great help), I got him buoyant (he sunk and drowned - so was only just below the surface when I reached him)... towed him a short distance and one-arm hauled him up a slipway within seconds. He recovered breathing upon stimulation and was aero-med evacuated within 20 minutes - survived, thankfully.

I just don't envision many circumstances where any more than a couple of initial breaths would be positive.

 

[Griffo]

And as many times as a DMC,DM, and instructor I have had my head shoved under water by someone trying to get in position to deliver and effective rescue breath on the first try has convinced me that only instructors, DM's, and those who practice the skill on a REGULAR basis should attempt it. Otherwise haul butt and get the vic to some help. And what some seem to be missing is that properly trained divers, diving as a buddy team are not likely to need to help each other. But the buddy team is very likely to come upon someone who was not as well trained, has not kept up on their skills, just may be a screw up, or for whatever reason ends up panicked. That is why I put as much if not more emphasis on effecting a rescue as a team as opposed to an individual doing it. In that case towing and stripping is a much easier task and rescue breathing may be a possible avenue of action. But even then if they don't practice it regularly getting the vic out of the water is the primary concern.

So I just did rescue with an Instructor that was PADI, SSI and BSAC. Although as an SSI course we "followed" the SSI curriculum, he went through the three different agencies take on most things. One thing that stood out for me was the rescue breaths. Both SSI and PADI had the "over the top" method which I just found stupid. The BSAC method twisted the diver so that you were doing nose breaths where you remained in a vertical position with the divers head well out of the water. Seemed far easier to do without forcing more water into the divers lungs. Both BSAC and SSI seemed to promote the speed in getting the diver out of the water over doing rescue breaths, and BSAC seemed to extend that mentality even further to the unconscious diver ascent as well. It could have been the teachers bias, but the PADI techniques seemed the least in line with the ethos I got from my EFR refresher which does away with anything that slows down getting that blooding circulating as the highest of all priorities.

 

[ozzydamo]

For me the number one thing would be getting the boat master to see/hear your in trouble! (HELP, HELP, HELP! Waving one arm in a wide arch).

What they teach you and what you might do if it really happened are very different things-another good reason for solo diving.........

 

[DevonDiver]

For me the number one thing would be getting the boat master to see/hear your in trouble! (HELP, HELP, HELP! Waving one arm in a wide arch).

A good strategy in some places, but not others. If nothing else, it might wake a Thai boatman up.....

What they teach you and what you might do if it really happened are very different things-another good reason for solo diving.........

I see no relevance to solo diving in this thread, unless you only dive places where there are no other divers as a rule. Otherwise, on a charter boat or busy shore-site, there'll be other divers around and your rescue skills could be called for, even as a bystander (diver).

Most Rescue courses are taught upon the basis that any response is better than none... and that a given situation can easily mean that a 'textbook' solution isn't valid. The ability to adapt is critical.

That said, if you cannot 'do' what you are taught... or forget to do so.... then it highlights a failure to properly learn and/or embed skills post-training.

I don't see why 'solo diving' always seems to be flouted as a resolution to sloppy dive skills. Such a mindset seems, IMHO, the antithesis to what solo diving is all about...

 

[Dive-aholic]

Hmmm. For nearshore or a close boat: 2 or 3 breaths to make a possible drowning victim release a laryngospasm(which to my limited knowledge almost always occurs), then swim as fast as possible without endangering self towards nearest hard surface, stripping gear as you go, and begin CPR once you get there, breaths and compressions if willing, compressions only otherwise. Seems straight forward enough.

Why is stripping gear hard? If someone is on their back (in a vest BCD at least:tongue2 its clip, velcro, clip, clip, clip and everything falls away.

And since we are thinking outside of the cirriculum...
OK, now having lurked the recent and older cpr threads, having just gotten my fa/cpr cert, and some out of the box googling, how about this for a response:
Dont strip down the unconcious diver, inflate their BCD, blow hard across their face a few times while smacking lightly, give them two or three breaths, put their mask back on(being sure it seals well, if thats doable at all), put their reg back in, and ROLL THEM FACE DOWN, and then while holding the reg into make a good seal, drag them by the head as fast as you can. Make sure they have air in their tank. This might work if you are far from a hard surface as well.
:flame: away!

Maybe leave them face up and mask off but drape a sure-to-be soaked towel across their face.

:zen:

Seriously? Do you know how difficult it is to keep a regulator in the mouth of an unconscious person and make sure it has a seal? I do and I had the help of 3 others. It's extremely difficult and was of no use. The only reason we had to do it that way is because we were 900' in side a cave and had no surface. My 1st instinct was to bring him to an air pocket but there were none. I will always try to get the victim's face out of the water.