Rescue Diver Training Becomes Real Thing!

[SC_Hoaty]

...Also, I understand that the policy of ScubaBoard is that accident / incident details and analysis must be submitted for moderator review before posting, consequently I won't post details here....

I believe those are the rules for the Mishap Analysis subforum only. There are special rules for this forum, found in a sticky thread.

Thanks for providing all the details that you have.

 

[Neuatomic]

According the doctor, this diver nearly drowns, not from ingesting sea water but from over expanding his lungs and causing interstitial body fluid to enter as a result of sucking too hard on an empty SCUBA tank. The fluid in his lungs gave him sensation of suffocating / drowning and he was actually drowning because his capacity to absorb oxygen was reduced.

The doctor reported to the group that the injury was NOT related to nitrogen loading and NOT decompression sickness. He was taken to a hyperbaric chamber but not put in. He was put on straight oxygen and bed rest for 2 days. He was back to nearly normal by day three.

Those interested in reading more discussion regarding Immersion Pulmonary Edema may wish to have a look at denisegg's recent experience.

(My emphasis via italics and underlining) Question: would this be more descriptive (the doctor's explanation) of a lung overexpansion injury (pulmonary barotrauma) rather than IPE? Would just sucking very hard on an empty tank lead to a barotrauma, or would that have to be combined with an ascent (i.e. never hold your breath)?

 

[DandyDon]

According the doctor, this diver nearly drowns, not from ingesting sea water but from over expanding his lungs and causing interstitial body fluid to enter as a result of sucking too hard on an empty SCUBA tank. The fluid in his lungs gave him sensation of suffocating / drowning and he was actually drowning because his capacity to absorb oxygen was reduced.

The doctor reported to the group that the injury was NOT related to nitrogen loading and NOT decompression sickness. He was taken to a hyperbaric chamber but not put in. He was put on straight oxygen and bed rest for 2 days. He was back to nearly normal by day three.

(My emphasis via italics and underlining) Question: would this be more descriptive (the doctor's explanation) of a lung overexpansion injury (pulmonary barotrauma) rather than IPE? Would just sucking very hard on an empty tank lead to a barotrauma, or would that have to be combined with an ascent (i.e. never hold your breath)?

I don't know what you were attempting to put into italics as everything in a quotes goes that way, but while the physician onboard may well have said that sucking a dry tank caused the injury - I think that was a slip of words at an excited time. Most doctors don't know much about diving injuries anyway, as was the case in http://www.scubaboard.com/forums/ac...eniseggs-incident-near-miss-jackson-blue.html but while this doc might have meant lung over expansion from holding his breath, it just might have come out wrong. Lucky he was there tho, very lucky. Physicians should always be allowed free diving.

I screwed up badly on a first dive of a trip last year, virtually ran out of air at 50 ft or so, and did my first ever real Cesa. It's tempting to hold your breath and my embarrassment my have clouded my actions but sometimes you have One Friggin Second to decide how you're going to save your ass* and I fumbled thru it. I try to warn people that I am a klutz diver and while I work hard at safety to compensate, I'm still a klutz. See http://www.scubaboard.com/forums/ne...so-its-time-me-post-my-cozumel-screw-ups.html

I forget what the terms mean at times, and certainly forget the initials. A good article on Pulmonary Barotrauma, which we try to avoid by never holding our breath and making sure we are fit to dive can be seen at DAN Divers Alert Network : Scanning for Blebs I suspect the ex-Inst goofed and held his breath on the last few feet, but that just might have been caused by IPE; it's really hard to say here. Since he did not require the chamber, maybe it was IPE?

Immersion Pulmonary Edema just doesn't make sense to me but certainly happens; see this article DAN Divers Alert Network : Immersion Pulmonary Edema

This is the first actual emergency ever experienced by the any of the three instructor/divemasters onboard. Fortunately, an M.D. diver is onboard and assists.

Utila is touted as the cheapest place to gain training as a DM or Inst so it's common to get DMs who know what they're doing ok, but still not as experienced as some. They do have a nice chamber & clinic or so it looked like when I toured it once years ago. I didn't know they had an ambulance boat - cool.

I once has an ex-Inst for a dive bud on the first dive of a trip, who hadn't dived in years. She should have gone to retraining after all that time, but well it was an easy dive. I'm an air hog, finished my tank first, and she blew me off for the ascent so I refused to diver with her after that. If I have to ascend alone anyway, I'd rather solo dive with my pony and know where I stand - potentially dangerous part of a the dive.

* From the One Friggin Second to decide how you're going to save your ass department: Damned road idiot ran a stop sign today, finally halting only halfway across my hood as I was tooling along 5 mph below the posted 55 in the right lane. That's how I bought my last two pickups, but I braked & swerved enough to miss him. I was tempted to turn around and chase him as he had to turn at the T and certainly went the other way, but fortunately blew it off.

 

[Bogie]

I am glad everyone is OK. Thanks for the informative thread.

 

[Down2bizDiver]

... the physician onboard may well have said that sucking a dry tank caused the injury ... this doc might have meant lung over expansion from holding his breath ... they do have a nice chamber & clinic or so it looked like when I toured it once years ago. I didn't know they had an ambulance boat.

NOT lung over-expansion from holding breath on ascent.

Doc reported that the clinic/hospital lacked even basic diagnostic and treatment equipment, therefore decided to take victim back to resort where doctor could watch in person rather than "by radio" as suggested by untrained personnel at the clinic/hospital/chamber. Doctor reported he intends to make donation of some basic equipment.

The DM/Instructors on the boat were not from Utila and not trained at Utila. One from Canada, one from Chile, one from Germany.

Not an ambulance boat, it was dive boat captain father's one man fishing boat, a really nice super fast one! It could make the trip from the dive site to town in about 20 minutes while the slow dive boat would have taken an hour or more, according to the captain.

Although the victim had DAN insurance it merely provides reimbursement ... you have to pay out of pocket, get receipts, submit to DAN, wait for check. Neither the victim nor his buddy had ability to pay on the spot so the doctor arranged funds transfer and paid on behalf of victim for speedboat, clinic services, oxygen tanks, meds at pharmacy, etc.

 

[DandyDon]

Okl, thanks for the corrected info. I'm not clear on this first part tho...

NOT lung over-expansion from holding breath on ascent.

You'd mentioned the doc saying "According the doctor, this diver nearly drowns, not from ingesting sea water but from over expanding his lungs and causing interstitial body fluid"
The physician did say over expansion? Sucking wouldn't do that, just the opposite, so what am I missing?

Doc reported that the clinic/hospital lacked even basic diagnostic and treatment equipment, therefore decided to take victim back to resort where doctor could watch in person rather than "by radio" as suggested by untrained personnel at the clinic/hospital/chamber. Doctor reported he intends to make donation of some basic equipment.

It looked nice to me, but then I'd never seen a chamber before. I guess it's a typical remote destination first aid clinic. Was there an attempt to get him transported back to the US, or not deemed needed? Was DAN consulted on the case?

The ex-Inst I mentioned refusing to dive with in my last post went on to take an undeserved hit later in the day. She was flown back to Miami for a couple of weeks of ICU and they never did figure out why.

The DM/Instructors on the boat were not from Utila and not trained at Utila. One from Canada, one from Chile, one from Germany.

Not an ambulance boat, it was dive boat captain father's one man fishing boat, a really nice super fast one! It could make the trip from the dive site to town in about 20 minutes while the slow dive boat would have taken an hour or more, according to the captain.

Ah, ok.

Although the victim had DAN insurance it merely provides reimbursement ... you have to pay out of pocket, get receipts, submit to DAN, wait for check. Neither the victim nor his buddy had ability to pay on the spot so the doctor arranged funds transfer and paid on behalf of victim for speedboat, clinic services, oxygen tanks, meds at pharmacy, etc.

Yeah, that's always a risk too. DAN can guarantee funds and even prepay by wiring money in some cases, but ultimately insurance is just insurance. Really good of the doctor to pitch in so well. :medal:

 

[Duke Dive Medicine]

Down2Biz, thanks for the informative video. Nothing like seeing the real thing to make one think about one would do in a situation like that. A couple of notes: first, well done to the boat crew on getting the diver on O2 right away. Second (and this isn't a critique of you personally, just a general note to all) it looks as if someone tried to put the diver in left lateral Trendelenburg position. For a long time, this was the recommendation for a diver with suspected AGE since it was thought that the additional pressure would force bubbles through the arterial circulation of the brain. Nowadays, the left lateral is appropriate, but the Trendelenburg part is no longer recommended as it can increase intracranial pressure in a victim with a gas embolism or brain DCS.
Regarding the physician's statement that the diver sucked so hard on an empty tank that he gave himself pulmonary edema: I think you'd have to try awfully hard to do that. A more reasonable explanation is either drowning, or possibly IPE as another poster suggested. The water looks pretty warm so this makes IPE less likely. If the diver had inhaled some water, that could cause pulmonary edema and subsequent hypoxia.
Regards,
DDM

 

[Down2bizDiver]

When the doctor was explaining the situation to the group he said that in low psi situations big people, especially big men like Victim and, pointing to me, Down2 who have big chests and powerful muscles can over expand their lungs by expanding their chests in an effort to draw in more air. He said this caused contusion or bruising and associated swelling. This makes perfect sense to me as a layman.

In my experience (190 dives in last 12 months), when a tank has 500 or more psi, when I inhale the air just sort of flows in easily, I'm not sucking, I'm just breathing normally and air flows easily. My 2nd stage reg has an adjustment knob and I can set it so that air flows in so easily it is just one step away from free flowing. I can also turn it down so that it takes a bit of effort to breath in. One time I myself had a tank down to nearly 200 psi and in my experience below about 450 psi I had to work to draw in the air, suck it in, coax it out of the tank so to speak, in the same way, but more extreme, as when I dial down my 2nd stage knob.

Victim reported to me that at the safety stop, when he stopped buddy breathing and went back to his own tank, he had less than 500 psi indicated and he thought that was enough for the 3 minute stop but it became so difficult to breathe he aborted the stop and went to the surface. Why didn't he go back to buddy breathing? He didn't say. Of course, safety stops are optional, good practice, not mandatory nor absolutely necessary. The doctor's explanation made sense to me.

Did the victim have some undiagnosed underlying contributing medical condition? No one knows. He reported that he had not been to see a doctor for any reason in "many years." I had been diving with him for several days, we had dinner and cocktails (not excessive) together the previous night and I had breakfast with him that morning at which times I noticed nothing unusual.

As for the position of the victim on the floor of the boat, he was coughing up fluid, there were three instructors onboard who were in the process of teaching a rescue diver course, and a doctor who dives was there. If what they were doing was not good practice then PADI, DAN and the rest need to get the word out to certified rescue divers and instructors!

According to my dive computer, water temperature at depth was 79F. Air temp was around 80F.

Doctor reported no sea water in victims lungs.

I have no rescue or other relevant training. I would have assisted if needed but I was not asked to to anything. I merely pointed my camera in the direction of the activity.

 

[Dr Wu]

I merely pointed my camera in the direction of the activity.

How does the victim feel about you posting his incident on the Internet?

 

[DandyDon]

Boo...!!