Rescue Course -- Should it be changed?

[DevonDiver]

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.

I don't think anybody said it was hard. However, people have talked about SPEED. Stripping gear slows things down considerably.

...some out of the box googling, how about this for a response... put their mask back on...put their reg back in, and ROLL THEM FACE DOWN,

Breathing resistance. Increasing it is hardly an optimum strategy for someone who will be struggling to breath effectively...

 

[haumana ronin]

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.

I have never tried with someone actually unconcious. But on the surface and with both hands, it seems easier. The reason I am saying both hands is because I am saying to actually drag them around by the head while squishing their jaw shut. But again, never tried it on someone actually unconcious rather than pretending to be unconcious.

I don't think anybody said it was hard. However, people have talked about SPEED. Stripping gear slows things down considerably.

I wasnt quite clear when I said hard; I meant hard to do quickly. 4 quick releases and a velcro strip all in close proximity on the front of the torso? 3 to 5 seconds, maybe 6 tops. Where I could imagine it being slow is if one tried to slide the victim out of the various loops. And I can only say for vests as I have never examined a BP/W for long. What am I missing?

Breathing resistance. Increasing it is hardly an optimum strategy for someone who will be struggling to breath effectively...

I am under the assumption they they are not breathing. The way I see it, if they are breathing on the surface, in whatever form, then they might need rescuing, not Rescuing.

So what I was thinking (now again, this is out of the box) is to induce the dive reflex to have the victims oxygen use go down and blood shunted to their core. Its the story about the little boy who fell in the lake for 30 minutes but was ok sorta thing. The interwebs :internet: say that the dive reflex on land has been shown to increase the victims odds a bit, and a increase it a lot for victims who are out of it over 5 minutes. Maybe false, but maybe true.

I wonder if swimming around with the victim around face up is the same as dragging a person around on land face up, which is essentially nothing, biologically. If they arent breathing, they arent breathing. I dont know the published odds for spontaneous respitory or cardiac self recovery after the first 15 or so seconds, but I am sure it is pretty low, otherwise the red cross cpr class would be just "let them sleep it off, theyll wake up in a bit." And I think that replacing the reg may cover that improbablity and provide a source for the terminal gasp.

:idea:I know this is counter-intuitive, and pretty much way out there, but if something reduces the victims odds by 2% because of one factor but raises it by 10% because of another for a net gain of 8%, maybe this something is worth considering.

:zen:

 

[DevonDiver]

I wasnt quite clear when I said hard; I meant hard to do quickly. 4 quick releases and a velcro strip all in close proximity on the front of the torso? 3 to 5 seconds, maybe 6 tops. Where I could imagine it being slow is if one tried to slide the victim out of the various loops. And I can only say for vests as I have never examined a BP/W for long. What am I missing?

Missing - the cumulative time to raise and evacuate a victim, versus the time to brain damage for a non-breathing casualty.

Time yourself on a run-through practice - raise the victim from a realistic depth, establish buoyancy, establish respiration or not, tow them to egress, then egress.

Every rescue course I run involves a stop-watch. Students learn pretty quickly that they don't have time to waste... and a 'few seconds here' and 'a few seconds there' makes a lot of difference over the whole scenario. Enough difference to potentially save, or cost, a life.

Very rarely will a diver be unsupported when conducting a rescue. There'll normally be people/staff on the boat. IMHO, removing kit in the water isn't critical under those circumstances - one or two grown men can easily haul a diver, with kit, out of the water. In many ways, having the kit in place makes it easier, because there is something to haul on.

IF unsupported and IF the rescuer is considerably outweighed by the victim, then yes... kit removal is something to be considered. IF not, it's a potential waste of time... and best deferred until proven necessary.

I am under the assumption they they are not breathing.

An assumption that could kill them.... if breathing shallow/slow and you don't notice that (easy).

So what I was thinking (now again, this is out of the box) is to induce the dive reflex to have the victims oxygen use go down and blood shunted to their core.... Its the story about the little boy who fell in the lake...

That's a very rare thing and tends to involve very cold water. There's too many proven 'cons' and no certain 'pros' to it.

 

[ktkt]

I wasnt quite clear when I said hard; I meant hard to do quickly. 4 quick releases and a velcro strip all in close proximity on the front of the torso? 3 to 5 seconds, maybe 6 tops. Where I could imagine it being slow is if one tried to slide the victim out of the various loops. And I can only say for vests as I have never examined a BP/W for long. What am I missing?

I am under the impression that many BP/w systems intentionally don't have quick release systems. That definitely would make things more difficult (and slower). Hopefully someone with experience will chime in.

That said, popping off a BC with quick releases should take basically no time at all, in my opinion, and it should barely slow you down at all. As long as you don't have to very carefully watch where you're going, just fin like mad as you mess with clips. It's totally doable.

I have only encountered two kinds of quick release clips -- the ones with a button you press in, and the standard clips that are all over everything (no idea what to call them, but you pinch the sides, and it pops open). Are there any that are noticeably different from these?

 

[Bob DBF]

I am under the impression that many BP/w systems intentionally don't have quick release systems. That definitely would make things more difficult (and slower). Hopefully someone with experience will chime in.

You will, most likly, find a Z knife or shears on their rig and use that to cut off the rig off them. It can be faster than screwing around with buckles.


Bob
------------------------------
“Improvise, Adapt and Overcome!”
― Clint Eastwood, Heartbreak Ridge

 

[USFpsychDiver]

I'm in the middle of rescue training (classroom & pool done, OW scenerios still to-be-done). I went and looked up the revised CPR recommendations as published by the American Heart Association in 2010:

"2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"

Turns out the recommendations depend on suspected etiology of the arrest (i.e. what caused it). In most instances the recommendations have changed from Airway, Breaths, Compressions (ABC) to Compressions, Airway, Breaths (CAB), BUT NOT IN THE CASE OF DROWNING, which remains ABC. From the executive summary (at http://circ.ahajournals.org/content/122/18_suppl_3/S640.full.pdf#page=1&view=FitH):

"It is reasonable for healthcare providers to tailor the sequence of rescue actions to the most likely cause of arrest. For example, if a lone healthcare provider sees a victim suddenly collapse, the provider may assume that the victim has suffered a sudden VF cardiac arrest; once the provider has verified that the victim is unresponsive and not breathing or is only gasping, the provider should immediately activate the emergency response system, get and use an AED, and give CPR. But for a presumed victim of drowning or other likely asphyxial arrest the priority would be to provide about 5 cycles (about 2 minutes) of conventional CPR (including rescue breathing) before activating the emergency response system. Also, in newly born infants, arrest is more likely to be of a respiratory etiology, and resuscitation should be attempted with the A-B-C sequence unless there is a known cardiac etiology."

While an unresponsive diver in the water may have had a heart attack as the primary event, it isn't unreasonable to suspect drowning, giving rescue breaths administration some priority.

 

[Xfiend]

I've never been through a rescue class, but I am a paramedic, and CPR is kinda my specialty. Here are a few brief points.
1) The seal created with mouth to mouth CPR is poor at best, even under the best of circumstances. I highly doubt anyone's ability to preform effective rescue breathing on someone floating in the water. Just like compressions, a solid surface behind the victim, a hand to open the airway, and a hand to close the noseare required to create that seal.
2) Without the blood circulating oxygen throughout the body (and most importantly, the brain), any oxygen forced into the lungs is wasted effort. If one could overcome laryngospasm with mouth to mouth cpr, and I'm not sure that its possible, an excellent seal would be required, see point 1.
3) EMS providers are taught to remove the victim from the hazard, prior to initiating care. Attempting medical procedures in atmospheres not conducive to human life not only adds more difficulty to a procedure with an already grim success rate, but also puts the rescuer at increased risk. A dead rescuer isn't a rescuer at all. They are another victim.

I'll be watching this tread with interest.

 

[Peter Guy]

For all of you who say it takes just a few seconds -- zip/zap -- to take a BCD off a diver don't appear to have:

a. Done this in cold water;

b. Done this with dry gloves (or heavy wet gloves);

c. Done this with a diver in a dry suit; and

d. Done this with a BCD you've never seen before.

It really isn't that easy some times.

 

[ozzydamo]

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

Westerner's living/working in 3rd-world countries with little remaining respect for humanity are at more risk to topping themselves, make sure you have an "out" strategy Action Man.

 

[raftingtigger]

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:

Some interesting thinking. But keep it just at that. I would be VERY careful about conducting a rescue using unproven/unstudied techniques. CPR has and is been carefully studied and adjusted for best results. These ideas go way outside the bounds of the variations (strip gear, don't, breath through the whole tow, only for a few breaths) being discussed here.