Holding a panicked diver down

[brnt999]

Let's talk about the legal issue.

A professional instructor or DM who is confronted with a situation in which a diver is about to make a panicked ascent has to make a decision. As Andy (DevonDiver) correctly points out, the greatest danger BY FAR is embolism due to holding the breath. Go to any one of the DAN annual fatality reports and see how many of those there are each year--quite a few. Some of you have talked about a diver dying because a professional held him down. I guess it may have happened, but I haven't seen it and would like someone to give a link to it. If it does happen, it is exceedingly rare. That is why, as Andy also points out, training for both the Rescue Diver (nonprofessional) and professional training call for the person to intervene in that panicked ascent.

So, first of all, what is the approach that is more likely to prevent an injury or death? Clearly, the consensus of the scuba industry says overwhelmingly that intervening in the ascent is correct.

So, let's say you are confronted with the situation and have to decide what to do. Here are some things to think about in legal terms.

1. If You intervene in the ascent in an attempt to prevent an embolism, you are acting according to your training and the directives of all scuba agencies. There is nearly no chance that it will create a fatality, and if it did, your defense is that you did the best you could while acting in accordance with what your training said is best practice. I can't imagine you could be held liable for following your training.

2. If you instead decide to let the person continue on that panicked ascent without intervening, there is a very good chance that the person will embolize and die. In that case, don't you think an attorney will want to question why you deliberately failed to follow the standard rescue protocols for which you were trained? I suspect that you would be in real trouble.

"I once had a guy panic at about 90 feet. I didn't have any time to do anything other than watch him bolt. He ended up ok."

This is an excerpt from the latest fatality review on DAN for 2006:

"Criteria for the diagnosis of AGE include direct (finding of gas in cerebral arteries, signs of
lung barotrauma) and circumstantial evidence (report of an emergency ascent; diver losing
consciousness soon after surfacing, with or without signs of distress), evidence of a rapid
ascent (electronic dive profile), and expert opinion of DAN reviewers. There were 15 cases
(33% of known) that met the criteria as illustrated by the following case.
A male diver in his late forties was an experienced diver with basic open-water certification.
He was diving with a group on a wreck to 130 fsw (40 msw). His deepest dive previously was
to 85 fsw (26 msw). Shortly after descending the diver panicked while at 90 fsw (27 msw).
The victim’s buddy and a dive instructor held the diver back as he tried to make a rapid
ascent and they all ascended together. On the surface the victim was breathing rapidly and
lost consciousness while being pulled to the boat. Resuscitation efforts were unsuccessful.
The autopsy demonstrated intravascular gas, pleural adhesions, and changes associated
with drowning. The cause of death was drowning and the disabling injury was an air
embolism that resulted from a rapid, panicked ascent."

So the facts are that of the tens of thousands of dives in 2006, 15 can be confirmed as AGE. I am curious of these 10's of thousands of dives, how many included a rapid ascent and, of this subclass, while 15 died how many didn't.

Holding someone back or down is a pretty intrusive procedure and I have no doubt the dive community established this standard based on the opinions of very wise, experienced, well educated, knowledgeable people. These people based their opinion on some objective and scientific data. Who am I to question them? I just have this morbid curiousity to look at all of the facts.
Where is this scientific data? Who specifically established this procedure? I would just like to look at the original data. To establish this intrusive standard they must have thought the probability of sustaining AGE was pretty high. I just want to know what is the probability--90%,75%, 50%.... and where is the scientific data and theory that established this probability.

 

[Crass3000]

I get what a lot of people are saying but I doubt someone is going to hold their breath on ascent if they have any breath left. I see holding someone down, without total assurance that they have a breath in them, as basically holding down a drowning victim. Although both are not TOTALLY true, I was told it's alot easier to fix a DCS victim (from a no DECO dive) than it is a drowning victim assuming they are shooting for the surface. He admitted that he had been bent a couple times but it was better than drowning. It's hard for me to imagine anybody holding their breath on such an ascent but I'm not the most experienced person here to be sure and have no problem admitting that.

Things would be different if I knew the problem was NOT an OOA/possible mouth full of water situation. Then I can see holding the person down to try to figure out the situation and calming them down while at the same time entertaining the idea of slowly bringing them to the surface given the particular situation.

 

[boulderjohn]

"I once had a guy panic at about 90 feet. I didn't have any time to do anything other than watch him bolt. He ended up ok."

This is an excerpt from the latest fatality review on DAN for 2006:

"Criteria for the diagnosis of AGE include direct (finding of gas in cerebral arteries, signs of
lung barotrauma) and circumstantial evidence (report of an emergency ascent; diver losing
consciousness soon after surfacing, with or without signs of distress), evidence of a rapid
ascent (electronic dive profile), and expert opinion of DAN reviewers. There were 15 cases
(33% of known) that met the criteria as illustrated by the following case.
A male diver in his late forties was an experienced diver with basic open-water certification.
He was diving with a group on a wreck to 130 fsw (40 msw). His deepest dive previously was
to 85 fsw (26 msw). Shortly after descending the diver panicked while at 90 fsw (27 msw).
The victim’s buddy and a dive instructor held the diver back as he tried to make a rapid
ascent and they all ascended together. On the surface the victim was breathing rapidly and
lost consciousness while being pulled to the boat. Resuscitation efforts were unsuccessful.
The autopsy demonstrated intravascular gas, pleural adhesions, and changes associated
with drowning. The cause of death was drowning and the disabling injury was an air
embolism that resulted from a rapid, panicked ascent."

So the facts are that of the tens of thousands of dives in 2006, 15 can be confirmed as AGE. I am curious of these 10's of thousands of dives, how many included a rapid ascent and, of this subclass, while 15 died how many didn't.

Holding someone back or down is a pretty intrusive procedure and I have no doubt the dive community established this standard based on the opinions of very wise, experienced, well educated, knowledgeable people. These people based their opinion on some objective and scientific data. Who am I to question them? I just have this morbid curiousity to look at all of the facts.
Where is this scientific data? Who specifically established this procedure? I would just like to look at the original data. To establish this intrusive standard they must have thought the probability of sustaining AGE was pretty high. I just want to know what is the probability--90%,75%, 50%.... and where is the scientific data and theory that established this probability.

I am not sure of your point in showing a case in which people attempted to to keep a guy from getting an embolism from a panicked ascent and failed. The conclusion was "the cause of death was drowning and the disabling injury was an air embolism that resulted from a rapid, panicked ascent." In other words, the intervention in that ascent was unsuccessful.

As I said, look at how many people die from an embolism following a panicked ascent each year, then see if you can find a case in which someone died because he was prevented from making a panicked ascent.

 

[redacted]

Holding someone back or down is a pretty intrusive procedure and I have no doubt the dive community established this standard based on the opinions of very wise, experienced, well educated, knowledgeable people. These people based their opinion on some objective and scientific data. Who am I to question them? I just have this morbid curiousity to look at all of the facts.
Where is this scientific data? Who specifically established this procedure? I would just like to look at the original data. To establish this intrusive standard they must have thought the probability of sustaining AGE was pretty high. I just want to know what is the probability--90%,75%, 50%.... and where is the scientific data and theory that established this probability.

I suspect that you give the "dive community" far too much credit.

 

[brnt999]

I am not sure of your point in showing a case in which people attempted to to keep a guy from getting an embolism from a panicked ascent and failed. The conclusion was "the cause of death was drowning and the disabling injury was an air embolism that resulted from a rapid, panicked ascent." In other words, the intervention in that ascent was unsuccessful.

As I said, look at how many people die from an embolism following a panicked ascent each year, then see if you can find a case in which someone died because he was prevented from making a panicked ascent.

I hate to be argumentative since you know a hell of a lot more than me. But I read that report as he was disabled by an air embolism but died of drowning. Is it possible ( just a question) that if they wouldn't have held him back he may have made it to the surface, injured by the embolism, but less affected by the effects of drowning and better off?

 

[boulderjohn]

I hate to be argumentative since you know a hell of a lot more than me. But I read that report as he was disabled by an air embolism but died of drowning. Is it possible ( just a question) that if they wouldn't have held him back he may have made it to the surface, injured by the embolism, but less affected by the effects of drowning and better off?

I have read every account of every death in the DAN reports over the past few years. Just about every air embolism death is by drowning. The diver is usually disabled before reaching the surface.

When I did my instructor training, we were required to watch a re-enactment of a student death in a swimming pool. The actors involved do everything to recreate exactly what happened in the actual incident. The student panicked and left the bottom of the deep end of the pool. She died when she reached the surface.

 

[TSandM]

You can dissect a lot of stories and ask all kinds of "what if?" questions that can't be answered.

I've already told you that your question about the frequency of AGE in breath-hold ascents cannot be answered. Nor do we know if some people experience an AGE with minimal or no symptoms, because those people wouldn't seek medical care. We DO know that breath-holding ascents, even short ones, CAN result in a fatal outcome. There is no effective treatment for the victim who has experienced a lethal gas embolism; I'm unaware of any case of cardiac arrest as a result of AGE where the diver has had a meaningful recovery. It IS, however, possible to resuscitate drowning victims, and it is done fairly often. If it were my friend or family member who appeared to be initiating a completely panicked, breath-hold ascent, I would take my chances on the possibility of them aspirating some water on the way up if I slow them, over the risk of an untreatable fatal problem.

An awful lot of diving questions suffer from the lack of a denominator, and this I'm sure is one. We don't know how many dives are done, how many divers panic, how many breath-hold ascents take place, or how many of those divers are injured. We do know that some of those breath-hold ascents result in irrecoverable arrests. In medicine, there are many situations where we know the likelihood of a problem is even vanishingly low, but the mortality of it, if undetected, is unacceptably high, so we test for those rare but horrible things, if the situation appears to merit it. I think AGE is something similar; even if it occurs in only a very small proportion of breath-hold ascents, it's so lethal that we need to try to prevent it.

Don't look for epidemiologic data. I'm sure there isn't any.

 

[boulderjohn]

Panic is a really bad thing, and it is extremely hard to deal effectively with a panicked diver. There is often nothing you can do.

There is a very famous case from the early days of cave diving. One of the most famous cave divers of his day, Bill Gavin (creator of Gavin Scooters) tried to help a highly experienced cave diver who went OOA. He gave him his regulator to share and did what was then the accepted air share technique of that day--he had the OOA diver hold on to the manifold (valves of his double tanks) while he tried to scooter them out. The OOA diver was in such a panic that he gripped the manifold with both hands and simply would not let go for any reason. Unfortunately, one reason would have been to vent the expanding air out of his dry suit. Because he didn't, he and Gavin were yanked to the roof of the cave and pinned to the ceiling. That is when the OOA diver likely embolized. He quite literally had a death grip on the manifold, and Gavin could not get free. Eventually, with help from another diver, Gavin got free just as his own air went to empty.

In summary, a highly experienced diver who had successfully gotten another air source still panicked, went to the surface, suffered an embolism, and drowned.

 

[dumpsterDiver]

You can dissect a lot of stories and ask all kinds of "what if?" questions that can't be answered.

I've already told you that your question about the frequency of AGE in breath-hold ascents cannot be answered. Nor do we know if some people experience an AGE with minimal or no symptoms, because those people wouldn't seek medical care. We DO know that breath-holding ascents, even short ones, CAN result in a fatal outcome. There is no effective treatment for the victim who has experienced a lethal gas embolism; I'm unaware of any case of cardiac arrest as a result of AGE where the diver has had a meaningful recovery. It IS, however, possible to resuscitate drowning victims, and it is done fairly often. If it were my friend or family member who appeared to be initiating a completely panicked, breath-hold ascent, I would take my chances on the possibility of them aspirating some water on the way up if I slow them, over the risk of an untreatable fatal problem.

An awful lot of diving questions suffer from the lack of a denominator, and this I'm sure is one. We don't know how many dives are done, how many divers panic, how many breath-hold ascents take place, or how many of those divers are injured. We do know that some of those breath-hold ascents result in irrecoverable arrests. In medicine, there are many situations where we know the likelihood of a problem is even vanishingly low, but the mortality of it, if undetected, is unacceptably high, so we test for those rare but horrible things, if the situation appears to merit it. I think AGE is something similar; even if it occurs in only a very small proportion of breath-hold ascents, it's so lethal that we need to try to prevent it.

Don't look for epidemiologic data. I'm sure there isn't any.

Do you really mean people holding their breath or people who are ascending without a regulator in their mouth?

 

[tflaris]

It's a situational dependent response. It's usually based upon the specifics of the situation at the time and dissected by Arm Chair warriors at the surface.