CPR in water when close to shore / boat what to do first?

[ArcticDiver]

Again . . .per the worst case blue water drift dive scenario above --what do you do if you cannot get the victim "to a place where good CPR can be done" within 5 to 10min, and you & the victim are downcurrent of a distant dive boat coming for recovery? You obviously are not going to waste time and physical effort by swim-towing the victim --against the current-- in order to hurry the rendezvous with the rescue boat. That doesn't make any sense at all. . .

Therefore, the best action is to attempt CPR --as best you can-- in the water, by the techniques above (modified Heimlich Maneuver) while awaiting pick-up by the rescuing boat.

Nope, in the scenario you posit both our lives are in jeopardy. In this case it is foolhardy to waste valuable energy performing an act that has no chance of success and, in fact, may make things worse. I have done things that had a low percentage of success gambling that the odds would fall on my side. Sometimes they did. But mostly they didn't. But I don't regret any of them. Anyone who does anything that risks their life and has no chance of success for the other person is just not thinking.

 

[haumana ronin]

Again . . .per the worst case blue water drift dive scenario above --what do you do if you cannot get the victim "to a place where good CPR can be done" within 5 to 10min, and you & the victim are downcurrent of a distant dive boat coming for recovery? You obviously are not going to waste time and physical effort by swim-towing the victim --against the current-- in order to hurry the rendezvous with the rescue boat. That doesn't make any sense at all. . .

Therefore, the best action is to attempt CPR --as best you can-- in the water, by the techniques above (modified Heimlich Maneuver) while awaiting pick-up by the rescuing boat.

File:Golden.png - Wikipedia, the free encyclopedia

Nope, in the scenario you posit both our lives are in jeopardy. In this case it is foolhardy to waste valuable energy performing an act that has no chance of success and, in fact, may make things worse. I have done things that had a low percentage of success gambling that the odds would fall on my side. Sometimes they did. But mostly they didn't. But I don't regret any of them. Anyone who does anything that risks their life and has no chance of success for the other person is just not thinking.

Does anyone have the statistics for "heimlich compressions" resucitations? What about for blue water heimlichs? I would like to think that I would at least try, even at the risk of extreme fatigue, in such a situation, but if there is a 00.000% chance....

:zen:

 

[AFD362]

I am with medic diver on this. While I would certainly not fault anyone for trying what they think is the right thing to do in an impossible situation far from help the reality is that the science of CPR is now almost overwhelming towards maintaining the circulation of the existing oxygenated blood. The only real way to do this is to get the victim to a hard surface ASAP. Many other variables also come into play so a couple of quick breaths may be effective in situations such as a near drowning or respitory issue but the reality is that most will not be able to detect this in an emergency (notice I said most, not all - so put down the axes). Traditionally the survival rate for full arrest victims has been poor at best and I have participated in many over the years that did not end well, however, with the focus shift that has taken place and the emphasis placed on effective compressions the survival rates for those patients found in either ventricular fibrillation or ventricular tachycardia who receive high performance CPR and early defibrillation has dramatically improved. Some agencies are reporting 30% save rates with the agency I work for approaching the 20% range. These are real and documented saves. For those patients found in a asystole (flatline) the numbers are about the same as they have always been. BTW, I will take issue with the comment of"just do 5 min of CPR and stop, no first responder I know does this or would even consider it, however, once a set criteria has been met such as ALS care for a defined period (usually 20-25 min with drugs and airway in place) we do terminate efforts in the field. I have also done this numerous times and it is not an easy thing to do. It should also be mentioned that it is often situation dependent. No one would leave a child or a physically fit diver as opposed to a known hospice patient or a patient with an unknown down time and an extensive medical
history. Policies across the country vary on this but no physician "on scene" is needed, just contact via medical control. It should also be mentioned that some agencies do not allow this at all. In 27 years as a medic, medic instructor
and FF I have seen many not make it, but the last 3-4 years have been different. Good compression work for those who are savable. Give them the best chance and get them to a place where you can do it. I'll get off my soap box now.

 

[victor]

My rescuse course was over 20 years ago now and I do not consider myself current. This is a certification that I feel should require a regular (maybe every 5 years) refresher. Thats not just an excuse for PADI to make more money. Changes in the field of emergency medecine should be reflected in the course content. Other subjects like search, etc would also benefit from a regular refresher.

 

[Kevrumbo]

Does anyone have the statistics for "heimlich compressions" resucitations? What about for blue water heimlichs? I would like to think that I would at least try, even at the risk of extreme fatigue, in such a situation, but if there is a 00.000% chance....

:zen:

No . . .this is entirely original, unique and "outside-the-box" technique & proposition. It's just a speculative "why not give it a try", last ditch attempt.

---------- Post Merged at 01:30 AM ---------- Previous Post was at 01:18 AM ----------

once again from a person who has experience doing this in all kinds of places the best action would be to get to the boat and do REALLY good chest compressions. I have had cpr work in less than optimal places, and also seen it go terrible in hospitals. Keep in mind the equipment you have on dive boat or in a remote location is very limited, In my ambulance i have drugs, a heart monitor, i.v. supplies, and intubation equipment, and to honest with you and i am sure some other people would agree with me, I have seen it not work more than i have seen it work. That being said you should always do what ever is necessary and be able to think outside of the box.

Nope, in the scenario you posit both our lives are in jeopardy. In this case it is foolhardy to waste valuable energy performing an act that has no chance of success and, in fact, may make things worse. I have done things that had a low percentage of success gambling that the odds would fall on my side. Sometimes they did. But mostly they didn't. But I don't regret any of them. Anyone who does anything that risks their life and has no chance of success for the other person is just not thinking.

I am with medic diver on this. While I would certainly not fault anyone for trying what they think is the right thing to do in an impossible situation far from help the reality is that the science of CPR is now almost overwhelming towards maintaining the circulation of the existing oxygenated blood. The only real way to do this is to get the victim to a hard surface ASAP. Many other variables also come into play so a couple of quick breaths may be effective in situations such as a near drowning or respitory issue but the reality is that most will not be able to detect this in an emergency (notice I said most, not all - so put down the axes). Traditionally the survival rate for full arrest victims has been poor at best and I have participated in many over the years that did not end well, however, with the focus shift that has taken place and the emphasis placed on effective compressions the survival rates for those patients found in either ventricular fibrillation or ventricular tachycardia who receive high performance CPR and early defibrillation has dramatically improved. Some agencies are reporting 30% save rates with the agency I work for approaching the 20% range. These are real and documented saves. For those patients found in a asystole (flatline) the numbers are about the same as they have always been. BTW, I will take issue with the comment of"just do 5 min of CPR and stop, no first responder I know does this or would even consider it, however, once a set criteria has been met such as ALS care for a defined period (usually 20-25 min with drugs and airway in place) we do terminate efforts in the field. I have also done this numerous times and it is not an easy thing to do. It should also be mentioned that it is often situation dependent. No one would leave a child or a physically fit diver as opposed to a known hospice patient or a patient with an unknown down time and an extensive medical
history. Policies across the country vary on this but no physician "on scene" is needed, just contact via medical control. It should also be mentioned that some agencies do not allow this at all. In 27 years as a medic, medic instructor
and FF I have seen many not make it, but the last 3-4 years have been different. Good compression work for those who are savable. Give them the best chance and get them to a place where you can do it. I'll get off my soap box now.

To the Physician and EMS Professionals in this thread --You may rationalize & justify your actions (or inaction) based on your clinical and/or field experiences (Doctor you can just officially pronounce the victim as you see it and as the case eventually may be. . .).

I'm only a First Responder --and admittedly a naive layman in this hypothetical worst case instance-- but I refuse to do nothing and just watch this victim die.

I will do whatever I can for as long as I can. . .

Again . . .per the worst case blue water drift dive scenario above --what do you do if you cannot get the victim "to a place where good CPR can be done" within 5 to 10min, and you & the victim are downcurrent of a distant dive boat coming for recovery? You obviously are not going to waste time and physical effort by swim-towing the victim --against the current-- in order to hurry the rendezvous with the rescue boat. That doesn't make any sense at all. . .

Therefore, the best action is to attempt CPR --as best you can-- in the water, by the techniques above (modified Heimlich Maneuver) while awaiting pick-up by the rescuing boat.

File:Golden.png - Wikipedia, the free encyclopedia

 

[supergaijin]

KevRumbo I believe there's a difference in scenarios that you are posting. Your scenario involves you waiting for a boat pickup. In that case, I would be trying what I could to shift blood around- like the modified Heimlich.

The other scenarios involves having to tow the diver to shore/boat- this in turn is broken down to tows of under/over 5mins.

The thinking now is (as stated before)
a) if you can do it in under 5mins- haul ass and get to shore where effective CPR can be performed.
b) if over 5 mins, doing some rescue breaths along the way probably won't hurt.

One of the reasons I do not like teaching the Rescue course is that I do not agree with the process of mucking around with Do-si-do dance while towing a diver to shore. IMO, it's 2 breaths and haul ass, taking off equipment as you go.

From what I understand, there is a difference between adults and kids when it comes to rescue.
Kids stop breathing but sometimes the heart is still pumping, thus rescue breathing is more effective.
For adults, the heart stops pretty soon after the breathing, in which case, rescue breaths alone is ineffective. The caveat is that you don't know whether the heart is stopped or not.

I always thought that doing CPR on a patient with a heartbeat is extremely dangerous- thus it is always necessary to check for pulse. I read earlier in this thread that some courses were just giving priority to getting chest compressions going asap? Doctors- what say you?

 

[Kevrumbo]

I have never been fully convinced on CPR while floating, if a hard surface (boat or shore) is nearby. The decision for a fast tow to shore or start CPR is a difficult one.
Maybe a qualified medic can give us an answer to this.

Oviously too much time away from the sea :daydreaming:

Okay, worst case scenario aside, you gotta have some established parameters beforehand . . .will you be closer to shore than a recovering boat and can you summon help from land as well while performing CPR? Or did you just beach yourself and the full arrest victim on a remote shore where no additional aid is available? Can a rescue skiff pick you up on the beach, or is that beach in rough surf with a fringing coral reef? Is the dive boat the only means of rescue, or can they call in a chopper like the US Coast Guard for medevac whether you're performing CPR on shore or in the boat?

Issues like those above should be made clear for a specific contingency plan during the pre-dive briefing by the operation's boat crews, dive guides/divemasters . . .

 

[wtcreaux]

but I refuse to do nothing and just watch this victim die.

. .

In the scenario presented, the victim is already dead (clinical - the cessation of breathing and pulse). What we, as 1st responders/civilians/EMTs/medical professionals, try to do is to prevent biological death (death of cells/tissue/organism) through intervening with, in the instance of cardiac event, cardiac compressions, medications, and defibrillation.

I know this may sound nit-picky (or a matter of semantics) but look at it this way. If I do nothing, the patient/victim will proceed to biological death. If I do something, they may or may not proceed.

The point is - they are already dead. ANYTHING you do, may (or may not) prevent it from being biological (permanent). (And yes, I will exhaust ALL means if it were my daughter, healthy. But I also know that I would be limited with my wife who has a multitude of comorbid factors, doesn't mean I don't try).

 

[divin'dog]

I was actually thinking the same thing as Kevrumbo (is that possible?)... Has anyone tried to do in-water compressions from behind? Can a person actually get their arms around the victim after stripping off the equipment? Wetsuits make people bigger around... One thing about doing a compression from behind (or even a Heimlich Maneuver), is getting the proper leverage to squeeze. Most people will use their arms only (think biceps) and will not have the strength to do a compression. If you use your back and lats to squeeze by pulling your elbows toward you it will give you more power (using your core) but still don't know if it will be enough. Of course it is dependent whether the rescuer is a big guy and the victim is a petite woman. That being said, in-water compression is the very last thing I would attempt, if at all possible and it probably wouldn't be at the required rhythm (see below) but I would try to save someone's life as long as I don't become a 2nd victim (unless that person happens to be a loved one in which case reasoning kinda goes out the window).

The EMT that trained me said to just get the victim to solid surface fast! As others have said, there is enough O2 in the blood (for a short while) but compressions are paramount. I think giving 2 quick breaths (as Lynn reasoned) is worth it. My training was to strip the victim of equipment while towing which I think is a waste of time unless, in the end, you will save time by stripping the victim to make the tow faster (I would think over a long distance or a tough tow with surge or swells, you're tired, victim is big-you are small, etc). Do what will give you a faster tow to a hard surface.

Also, the required beat for compressions is about the same as the song Staying Alive by the Bee Gees!!! So if you're not sure of your timing, start singing Staying Alive while doing compressions.

 

[supergaijin]

Issues like those above should be made clear for a specific contingency plan during the pre-dive briefing by the operation's boat crews, dive guides/divemasters . . .

I can see it now:

"OK everybody, briefing time!! Welcome to Shark Point, a coral reef that begins at blah blah......
...... and in this scenario you're holding on to a shipping lane beacon with some flotsam nearby containing a child's bicycle tire, a kitchen spatula and half a polystyrene box- what do you do?! What do you do?!!!! ......." (finish briefing)

....... "aw crap it's night..... OK in the previous scenarios but this time in fading light, firstly we ....."