Rescue Questions

[don Francisco]

part of looking after yourself is ensuring you follow accepted protocols: sending a patient on a buoyant ascent may muddy the waters of responsibility, especially if it results in embolism or similar DCI.

Very important point. An important part of a rescue is not putting yourself at risk, and that also includes after the fact legal risk.

Even though good samaritan laws should protect you, it's important that you stick to accepted practice and can justify your actions if called upon to do so. Once you lift an unconscious person off the bottom, you accept a degree of responsibility for his welfare, and might be hard pressed to explain why you simply blew him up to the surface unattended.

An exception might be if you were in Deco and this was your only option, otherwise once you take charge, you need to stay with him, and move with all reasonable speed to get him to where you can provide appropriate care or hand him off to better qualified and equiped responders.

 

[NudeDiver]

split decision - is it better to be bent or dead? So that's a choice yo have to make - better to be seriously injured or dead?

It depends on the nature of the serious injury. If it is something that can heal - then I'll take the injury. But if it something that doesn't heal - brain damage, an amputation, paralysis, or some other such thing - please, please, please - just let me die.

 

[Jmarsland]

I'm getting ready to take my Rescue Diver course and I haven't read any of the materials but that is something that I hadn't really thought about when reading about other rescues! Thanks for bringing up that point. It also made me think about the good samaritan laws and how they differ state-state.

Makes me glad we have to take EFR to get Rescue Diver!

 

[LastManOut]

i'd suggest that checking for pulse underwater is going to be extremely difficult, and the chance of getting a false negative (find no pulse when there actually is one) is quite high. i wouldn't want to rely on my ability to find a pulse in that situation.

Good call. You don't check for a pulse at all. Period. Waste of time.

If they are wearing a drysuit or even a semi/wetsuit with a neck seal, carotid will be hard to find, esp. in larger patients.

Radial is going to be hard to find especially in cold water, as they will probably be experiencing peripheral vasoconstriction (blood leaving extremities)... makes it much harder to find. Wrist seals and computers and gloves etc also make it hard.

Also, the old method of checking for pupillary light reflex on the surface to determine a pulse needs to done in both eyes incase there is uneven constriction due to dcs/emboli or any other sort of damage - hard work to do this under pressure and having both hands free AND keeping their head sorted

Time checking for a pulse is time you could be administering unconscious casualty rescue breaths and getting them out of the water.

 

[DeepSeaDan]

IMO, the most common sense approach to emergency response is to remember to refrain from locking one's thinking inside a box ( sorry, that metaphor is grossly over-used! ), by that I mean one must be able to adapt procedures to varying situations. Equally important is to remember your priorities:

> YOUR ( Rescuer ) safety comes absolutely FIRST.

> People live & die by way of A B C & bleeding.

With those primary criteria in mind, react as safely & as quickly as you can. With open circuit equipment, an "unconcious" casualty is likely a " v.s.a." ( vital signs absent ) casualty ( an exception could be a witnessed O2 tox. victim, where the buddy takes control instantly & protects the diver's airway while surfacing...), who has likely drowned. Such a casualty needs the surface & a flat, hard platform ( for resucitation ) as quickly as can be safely managed.

How you achieve your primary objectives can be analogised to a mechanic with a box full of tools, where you are the "Rescue Mechanic", & your "tool box" is your mind's store of retrievable procedural options, adapted to the circumstances you find yourself in.

As to your scenario of retrieving an "unconcious" casualty underwater, consider these thoughts:

> nature of casualty ( who is it? your buddy? An unknown diver you "happened upon?" )

If it is your buddy, you should have a good idea of the circumstances of their unconciousness, provided you were " buddy diving" - not "kinda diving together". You would then base your response on the known circumstances. Much of what you do will be based on your knowledge of your own personal capabilities & limitations. You MUST be honest with yourself, or risk personal injury in trying to do things beyond your limits. This may include allowing a casualty an unescorted trip to the surface because a controlled ascent together was beyond your abilities. Many a well-intentioned rescuer has suffered the consequences of striving to assist beyond what they can safely achieve, often with tragic results. Resist.

If you "happen upon" an unresponsive diver, they have likely drowned. You now must first consider your own circumstances:

> what is my buddy & mine's dive schedule? ( that's right - you SHOULD have another person along to assist in recovering this person to surface! ).

> How do "we" safely, effectively, get this person to the surface?

You priorities are now:

> your safety
> their airway ( protect it as best you can )
> their buoyancy ( control it as best you can )
> the surface ( as quickly & safely as possible )

Once on surface:

> all get positive

> check breathing. No breathing? Try several rescue breaths as best you can, if there is no response to ventillations, then...

...decide - how close is an adequate platform for c.p.r.? If your close, make all speed for it ( I personally wouldn't slow our speed up by trying to breathe for the casualty en route - they need circulating blood to move any O2 I give them, & I can't move their blood in the water ).

...if said platform is a long way off, tow & breathe for them the best you can, & hope for a miracle.

...then again, hope for a miracle always.

Best Fishes,
D.S.D.

 

[divetatoo]

Another to remember is the circumstances like water temperature. Things like hypothermia and Mammamlian Dive Reflex contribute Cold Water Near Drowning. It is the Golden Hour for less damage done with air deprivation. Also remember that trapped air can still expand when "shooting" to the top. And if there have been repetitive dives at great depths you can cause an air embolism that could kill a victim by shooting them to the top. As I agree and recognize that the rescuer's safety is number one we have to act within our scope of training or at least get someone who can act. I believe that most recue material is written to be safe for all involved.

I understand there are different scenarios and different emergencies, for me personally, I will keep with what I have been trained to do and not get to creative when dealing with other peoples lives, especially if there hasn't been any proof to substantiate that "creativity". As long as I am safe and able to assist someone, then I can and will.

 

[Crowley]

An unconscious person cannot hold his or her breath, but a blocked airway has the same effect.

The OP asked if you could just shoot an unconscious victim to the surface. There are reasons why you might be able to, and there are reasons not to. I was giving a reason why NOT to -- namely, that when the victim goes up on his own, no one is protecting the airway. So it isn't the ideal plan.

It also seemed that the OP was concerned about the 4 minute time limit before brain damage begins to occur. While that is a good rule of thumb, it is not universally true, especially in near-drowning victims. So I was trying to say, "Don't get in so much of a rush that you jeopardize yourself, or that you cause further damage to the victim."

I agree with the instructors' advice about what to do. I'm just throwing in some medical perspectives because someone asked.

Sorry if I made the water more muddy ...

Not at all - it's a judgement call you have to make at the time and you can't necessarily predict the outcome.

during my DAN senior level first aid training I was shown photographs of a NAvy Seal diver's brain - the guy was unresponsive underwater and his colleague recovered him and during the ascent, kept pressing the regulator purge button to provide him with more air. All that happened was that the (already unconcious) victim - already effectively dead - ended up with a multitude of embolisms which would not have improved the victims chances

In an emergency you rely on your training but there is also a certain amount of trust in luck. You do the best you can according to you training but that's about it.

And I go back to my original statement - you can't make it worse - so do the best you can. That's all your training asks for

Dive safe,

C.

 

[divengolf]

Very thought-provoking thread. Question for you instructors on the best position to assume when bring a non-responsve diver up. In Rescue I was taught (in most cases)to get behind into the knees on the tank position, then position the right hand on the reg. to keep it in the diver's mouth, and to keep the airway as straight as possible. Then use the left hand to handle bouyancy on both inflators. The downside is that you don't have your fins to assist in ascent rate control. I guess that you could grab the tank valve with the left hand, then release knees to use fins when you need to.

Is that best or are there other thoughts. I assuming the diver is using a single tank, but doubles may not make a lot of difference. I have not tried it with doubles-need to do so.

 

[DeepSeaDan]

Very thought-provoking thread. Question for you instructors on the best position to assume when bring a non-responsve diver up. In Rescue I was taught (in most cases)to get behind into the knees on the tank position, then position the right hand on the reg. to keep it in the diver's mouth, and to keep the airway as straight as possible. Then use the left hand to handle bouyancy on both inflators. The downside is that you don't have your fins to assist in ascent rate control. I guess that you could grab the tank valve with the left hand, then release knees to use fins when you need to.

Is that best or are there other thoughts. I assuming the diver is using a single tank, but doubles may not make a lot of difference. I have not tried it with doubles-need to do so.

...is in behind the "person" ( the latest Red Cross euphemism to replace the previous "victim", followed by "casualty"....not sure what's next ), with the rescuer's right hand dedicated to managing the person's airway while the rescuer's left hand controls buoyancy. A standard technique, but by no means the only one. With the criteria of airway control & buoyancy control in mind, I suggest that a rescuer's body position can be modified to suit the situation. For instance, when the person is wearing doubles or is of significant body size, I might prefer to manage them from a side-to position, with my right arm possibly snaked under their left armpit &/or their left bcd strap / webbing, then on to manage the chin. I've also ruminated over the idea of carrying a short line, with a quick-release clip for coupling to a convenient d-ring of the rescuee'. This might permit me a front-on positioning, with the added benefit of freeing up both hands. I have yet to test this idea in the water, but it seems to hold promise. I envision a wide-stance finning technique to accompany this position ( much the same as the finning I do when performing a "tank-valve tow").

Again, my point is to not get trapped into a set of fixed options. Rescue is dynamic, an adreneline-charged task of many variables. To be locked into a set of specific options does not speak to this reality; however, rescuer ability & limitations, conditions & circumstances will certainly influence what is doable & what is not.

How many of you have practiced a "two rescuer" recovery of an unresponsive person underwater? Not many I'd wager. Odd isn't it? We are told to buddy dive ( "vicinity" diving doesn't count! ) from day 1, yet our u/w rescue scenarios typically have us as the lone rescuer...

Regards,
DSD

 

[DeepSeaDan]

I understand there are different scenarios and different emergencies, for me personally, I will keep with what I have been trained to do and not get to creative when dealing with other peoples lives, especially if there hasn't been any proof to substantiate that "creativity". As long as I am safe and able to assist someone, then I can and will.

...where you are coming from. To be clear, I was not suggesting rescuers fly by the seat of their pants on a whim. To return to the "toolbox" analogy, a newer, less experienced & practiced rescuer may have but a set of philips drivers & a ball-peen hammer from which to draw on, whereas a grizzled veteran of many rescue sessions, who has played with all the tools in his chest, will have a greater selection of options to apply to the job at hand. Is there a recognized rescue manual out there that defines & describes all the tools in the box? If there is, I haven't found it.

In firefighting, we operate utilizing "standard operating guidelines" or s.o.g.'s. They used to be called "standard operating procedures", but experience taught us that the word "procedure" was too confining for the dynamics of fire-rescue ops. I see a parallel in scuba rescue. We need room within the accepted standard practices to adapt to varying / changing circumstances. This is not to suggest that negligent or irresponsible behaviour is acceptable. I cannot wrap a person's octo hose around their neck & tow them to the surface because I felt it was the right thing to do at the time. Such action goes well outside the bounds of standard practice. But I can modify my body position in an effort to more efficiently lift a person to surface.

Regards,
DSD