Medical Breathing trouble in cold water (possible IPO/IPE)

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DiveLikeAMuppet

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Location
UK
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I recently had my first real-world real emergency scenario where my dive buddy got into a life and death situation that turned out relatively well mainly thanks to the location. Here's a summary and thoughts as I certainly learned few things.

tl;dr: buddy suffered from either IPO and/or heart issues, got rescued and survived.

Background:
  • Location is an inland quarry with full facilities (gas, food, parking - this will become important later). At this time of year, water temperature tends to be about 8 degrees Celsius underwater, 3-4 degrees on the surface.
  • Instabuddy situation - we didn't know each other and we were diving together for the first time. Inland UK quarries generally prohibit solo diving so if all your regular dive buddies can't make it, you try your luck with Facebook groups. It can lead to meeting either new friends or interesting characters, so it's fun.
  • I was diving a CCR, my main aim for the day was to check few adjustments on my unit. My buddy was on OC twinset/doubles, air, and wanted to do a weight check, test his new gear (wing, drysuit) and get a bit of practice as he had a break in diving but otherwise had a large number of dives in the past.
  • We discussed the dive plan: spend first portion of the dive around one of the training platforms at 5 meters so that I can run few CCR drills and he can get comfortable in his gear, then down to about 20 meters and swim around the main attractions, ascend to a 12 meter shelf to see more attractions and then exit along a gentle slope.
  • I was to lead the dive as I know the quarry a bit, buddy was to follow as it was his first time there. We discussed possible poor visibility and using torch for communication. I mentioned that I have a blindspot on a CCR behind and above me and asked my buddy to stay outside of the blind spot.

My dive profile:
  • 0 - 12 minutes: 5 meters
  • 12 - 17 minutes: descend to 20 meters
  • 17 - 24 minutes: 20 meters swim, at some point around 22 minutes runtime we separated
  • 24 - 31 minutes: (my) ascent along a slope in a quarry towards exit

The dive and accient:
  • We spent some time on a training platform, I performed few drills, buddy was hapilly swimming around. Then we swam down to a wreck and I tried to find a way to the next attraction. The visilibity wasn't great as there was a lot of training going on and it has been raining a lot.
  • At some point, we got separated, I searched for few minutes and then headed towards quarry exit (mainly to avoid getting banned for solo-diving on a CCR).
  • I surfaced about a minute before my buddy. We were fairly far away from each other. I tried waving / getting his attention, and noticed he does't look comfortable so I swam towards him.
  • Buddy looked distressed but was communicating, didn't ask for help. I tried towing him towards shore but he could not breath while on his back.
  • My buddy and I somehow managed to get to a small pier near quarry entrance (I was holding him by the manifold). He then started turning blue in his face, his breathing was laborious and he was wheezing/making gurgling sounds - at that point I called for help from the shore.
  • Together with bystanders we removed his harness and got him on shore.
  • Quarry team carried him on a stretcher to a first aid room, put him on O2 and called an ambulance.
  • Ambulance carried him to hospital for further evaluation. It's a suspected IPO/IPE or a mild heartattack.
My thoughts and lessons learned:
  • Emergency plans matter (as DiveTalk taught us recently). The quarry team was top notch - once my buddy was on shore, they handled the whole situation, from first aid and calling an ambulance to taking care of buddy's gear and car. It made a massive difference and the main reason is that they specifically train for emergencies and have a plan.
  • If the accident happened on the ocean on a charter boat (together with our separation), it could've been a fatality. If this happened at other UK quarries that are not so well managed, the outcome might have been worse.
  • Call help sooner than you think, even if the casualty tells you that they are fine.
  • Standard rescue tow - casualty lying on their back, rescuer holds the casualty by the manifold and tows - didn't work as my buddy was not able to breath on his back. I can't remember what worked. This could've been a massive problem on a shore dive.
  • Getting a casualty on-shore is serious work, even someone who was physically smaller, even with help from shore.
  • I didn't have to cut my buddy's harness because I found a breakaway clip but it was close. Ezycut/trilobite or trauma shears would work in this situation, a dive knife won't.
  • Mirrors are useful and I should start using one. We had a communication breakdown as my buddy kept swimming in my blindspot (above and behind me) and didn't use his torch for communication (e.g. respond to torch OK signals), so I had to turn every minute to see if he is still there. At some point, I just assumed he still there as long as I can hear bubbles nearby - which is how we separated in a spot with poor visibility and a lot of other OC divers.
  • Physical fitness (probably) matters - we could all do a bit more cardio & lose a bit of weight.
 
Very possibly IPE.
 
It is only a short while ago that most people in the sport of scuba had never heard of IPE/IPO and even today those divers aware of it would be in a small minority. Maybe if all of us would talk to our dive buddies and other divers we know and suggest they do a little research we can eventually turn that into a majority and help save some lives.
 
Very possibly IPE.
Agreed.

Many of the symptoms sound very similar to an experience I had where a fellow student had IPE during the first dive for Deep cert.

Competent rescuers are key. In the case I was involved with the only thing that really didn't go right was that the dive operator (inland sinkhole) did not have/couldn't find an AED. As far as the rest of the people involved, probably couldn't have asked for a more competent crew. On the dive were one instructor and 4 students (including the victim). Myself and at least one other student had EFR/First Aid/CPR certs, instructor is an EFR/First Aid/CPR trainer, and another instructor (from same shop) was on land.

Everyone had a job and did it well. Victim made a full recovery and continues diving today. No further incidents that I know of.

In a later Rescue course I took, my instructor (same one) actually used this as an example of what not to expect as everything went so smoothly. There was actually another instructor with a group of OW students that thought it was a rescue course, and not a real rescue.
 
Maybe something else that should be emphasized is that over hydration can possibly increase the risk of IPE. I see so many people emphasizing the importance of hydration that people tend to over do it which can increase their risk. You certainly do not want to be dehydrated but don't go crazy. There is an interesting discussion here:

 
Maybe something else that should be emphasized is that over hydration can possibly increase the risk of IPE. I see so many people emphasizing the importance of hydration that people tend to over do it which can increase their risk. You certainly do not want to be dehydrated but don't go crazy. There is an interesting discussion here:

Agree about the over hydration. My friend who died from IPE in 2011 on a dive I organised, was a person who drank as much water as physically possible. This is of course before I had ever even heard about IPE.
 
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