The Last Dive's Chrissy Rouse -- would he have survived today?

[minamin13]

I meant my question to be about Chrissy Rouse's medical treatment on the surface, not what the father and son could have done differently to make their dive safer. But all opinions are entertaining

I wonder if part of the reason why Chrissy Rouse was depressurized from 165 feet within a matter of hours rather than kept at 165 feet for a few days was because he had to be accompanied by a nurse at all times. This nurse undergoes the same pressure treatment as the victim. Or at least that was the case when Bernie Chowdury himself was treated for the decompression sickness. Keeping Chrissy Rouse at 165 feet for a few days would have endangered the health of the nurse. However, am I wrong to assume that keeping Chrissy Rouse at 165 feet for a few days would have increased his chances of surviving?

And now for the realm of science fiction: Could they give a victim of an extreme case of the bends blood transfusions to replace the victim's own blood? I realize this doesn't reverse the damage already done to the body tissues, but it certainly might help with the off gassing, if the hyperbaric chamber is limited as far as pressurization capabilities.

 

[H2Andy]

However, am I wrong to assume that keeping Chrissy Rouse at 165 feet for a few days would have increased his chances of surviving?

i think you are wrong. you can't make up treatments like this on the fly. the longest
treatment the U.S. Navy has a (published) protocol for is around 40 hours, with a max time
at 165 feet of 2 hours (that's Treatment Table 4, btw)

what you're talking about is off the charts as far as NOAA and the US Navy
are concerned.

 

[BigJetDriver]

(1) I meant my question to be about Chrissy Rouse's medical treatment on the surface, not what the father and son could have done differently to make their dive safer. But all opinions are entertaining

(2) I wonder if part of the reason why Chrissy Rouse was depressurized from 165 feet within a matter of hours rather than kept at 165 feet for a few days was because he had to be accompanied by a nurse at all times. This nurse undergoes the same pressure treatment as the victim. Or at least that was the case when Bernie Chowdury himself was treated for the decompression sickness. Keeping Chrissy Rouse at 165 feet for a few days would have endangered the health of the nurse. However, am I wrong to assume that keeping Chrissy Rouse at 165 feet for a few days would have increased his chances of surviving?

(3) And now for the realm of science fiction: Could they give a victim of an extreme case of the bends blood transfusions to replace the victim's own blood? I realize this doesn't reverse the damage already done to the body tissues, but it certainly might help with the off gassing, if the hyperbaric chamber is limited as far as pressurization capabilities.

(1) I meant my answer in the same sense.

(2) I would have to interview the personnel at the chamber, but this is probably not the reason. Keeping him there would not have increased his chances.

(3) Whole blood transfusion would not have reversed the cascade reaction that been under way for some time, and would not have been able to reach the capillaries and tissue level given the massive bubble blockage.

The only thing that could have saved him, and his father, was IWR, and the conditions were such that it was not possible.

 

[scubapolly]

I guess we can all learn something from those books since they're based on true cases. I have read "Shadow Divers" "The Last Dive" "Deep Descent" "Dark Descent" and I stopped there. Reason? After reading "Shadow Divers", well the rest pales in comparison, and I'm not referring to content since the material has a lot of potential, but the writing style... Goodness! You can inmediately tell that the only real writer is Bob Kurson...

I totally agree. Shaddow divers is by far my favorite. Can't wait for the movie to come out. I heard from an inside sourse that Fall '07 is the projected release, although filming has yet to begin.

 

[Hoyden]

Out in the realm of speculation on their medical treatment, perhaps a chamber on the boat might have saved him- perhaps even both of them - I would guess that too much damage was done by the time Chrissy made it to a chamber at a hospital. This technology is not available to the average wreck diver today, but if I were to hit the lottery and build the ultimate boat to serve as a platform for offshore deep wreck diving, I'd want at least a monoplace chamber and someone trained to operate it on board.

If you want to analyze the actual dive the Rouses did, take any basic advanced nitrox/deco procedures course. They broke almost every rule rule currently taught in those classes and that's before you even consider the trimix issue. Hindsight is always 20/20 and certainly many divers compromise on one or two safety issues and survive, but make compromises often enough or on enough factors at once and it can lead to accident chains like the Rouses encountered.

Jackie

 

[MikeM878]

Chrissy's systems were shutting down...it didn't really matter at that point what depth he was at in the Chamber.

You need to get the patient up from 165 feet. The patient is probably getting about 2.8 atmos of O2 from his breathing gas, according to typical treatment tables, so CNS O2 toxicity is a real issue. So is narcossis for the patient, tender, and other medical staff that locks in.

If the ascent has to stop because of the condition of the patient, there are other treatment or contingency tables that can be switched to. But as I said before, Chrissy's fate was probably already decided, regardless of what table he was on, or whether or not he was even in the Chamber.

 

[Derek S]

I've read The Last Dive, and am in the process of reading Shadow Divers. I think that both of the Rouse's were unsavable once they broke the surface of the water.

Given the portrayal of Chris and Chrissy in TLD, one might guess that it was only a matter of time before their actions and attitudes caused them to injure themselves.

They chose to dive compressed air because they couldn't afford the trimix fills, when in reality, at that depth and adding the difficulties of penetration, they couldn't afford not to use trimix.

It's a shame it had to happen the way it did, it seemed to me that they really loved the sport and shouldn't have perished while doing it.

 

[MikeFerrara]

The point that the author of "Last Dive" makes is that what would have saved them more than anything else would have been a communication system between themselves and the surface. That would have been very cutting edge at the time they made their dives. Should that now be concidered "standard equipment" for the deep tech diver? I know it is expensive, but they did try to save money by breathing air, and even Chrissy Rouse beat himself up for that later. Just thowing it out.

I don't think communications to the surface is the answer. In this case they would have had trouble even tling some one at the surface where they were.

In the general case, lots of technical diving takes place in overheads like wrecks or caves and most underwater coms other than hard wired are ultrsonic. Ultasonic won't transmit through solid objects. Additionally, thermoclines and even turbidity can be a problem.

Currently there are a few people using radio, which can transmit through obstructions but I'm not aware of any that are commercially available. All the ones that I've seen have been home built jobs.

One of the big killers of technical divers is bad gas switches. IMO, anything that complicates switching gasses is a bad idea. Though the point can be argued, I think that full face masks complicate gas switches. I know there are manifolds available and so forth but keep in mind that sometimes several different gasses might be used during a dive. With switches to and from stages, two or more decompression gasses and back gas breaks at shallow stops, it doesn't take a very big dive to get to the point where you're making a dozen or more gas switches. Not to say that it can't be done but I haven't seen a system that I would trust. Add in the potential need to donate gas or swith to backups and it looks like a total nightmare to me.

In water support is a good idea for complicated or high risk dives but I think the surface is often just too far away for talking to any one there to be of much use.

 

[Dean810]

The reason I brought up communications, and I think one of the points Choudhury was making in his book, was that if they had a way to tell the surface of their gas problem, there might have been some way the boat could have staged gas for them so they wouldn't have had to make a direct accent to the surface. The accent was what killed them. I know very little about underwater communication systems, but I think their goose got cooked when they couldn't tell the surface of their problem. By the time the boat knew what was going on, it was too late.

 

[Dr Deco]

Hello minamin13:

This is only a response to the medical, recompression aspects of the dive. In addition, I only know what is in the book The Last Dive.

Rapid ascent

This ascent would not have allowed any regulation of the micronuclei, the maximum bubble size would have formed, and these would grow as dissolved nitrogen diffused into them. This blowup “decompression” was almost beyond any hope of a containable gas bubble volume.

Repressurization

If a chamber had been on the deck of the ship, repressurization might have saved the son. All commercial and military operations have access to a recompression chamber. Because of the massive gas volume, it is by no means certain that this would have helped.

When large volumes of gas bubbles are released into the venous return, it is almost a certainty that bubbles will enter the arterial circulation. When this occurs, there is, in effect, a stroke and a heart attack. These are the result of gas bubbles rather than blood clots, but the effects are similar. The result is neurological signs and heart arrhythmias. In severe cases, as this one was, the outcome is death.

While recompression can sometimes compress and release the gas phase [now in the form of cylinder while in the heart and brain vessels], if they have been there for a duration of several minutes, damage begins. Whether it is reversible depends on how extensive an area of the brain was embolized. The “plastic nature” of the brain would not allow for recovery if the embolization were of a more global nature; this probably occurred in this case.

Intravenous Adjuncts

This now moves into a more speculative area. It might have been possible to give IV fluids [saline], although this was a horrific bubble load. The pumping of the heart was compromised seriously.

There is the possibility that a surfactant might have been administered. We are now in the realm of a movie script with possibilities of something such as injecting polydimethlysiloxane. There have not been enough laboratory studies, and such a medication is not available even today for diving.

Hospital Treatment

Because the brain and heart were embolized, further improvement is purely conjectureal. I put this material in the SCUBA FORUM solely for teaching purposes.

A chamber capable of saturation therapy would have allowed a hold at a deep depth. Crew and patient could have received a lower oxygen dose that could be tolerated for longer durations. Such chamber capabilities are rare, however, outside of military and commercial deep sea operations. Saturation decompression is not standard in a hospital setting.

An exchange transfusion is certainly a possibility considering the certain changes in the blood. At the time this could be accomplished, with long travel time to the chamber, it probably would not have helped.

Again, this is only conjecture and discussion for ScubaBoard.

Dr Deco :doctor: