Closed Airway?

[KD8NPB]

I have not pursued a rescue diver course yet, but will be doing one next year.

Just curious, how do you deal with a closed airway underwater? Say worst comes to worst and your buddy sucks in water, his throat retaliates to the foreign liquid by closing. You can't exactly intubate underwater. How do you open the airway and prevent an embolism? Does a regulator purge create enough overpressure?

1/3 of near-drownings are dry-drownings in which the lungs have taken on no water...the throat has merely closed.

The first 3 minutes are obviously the most critical to restore breathing. There's a BVM & O2 on the boat, but again, that doesn't do you much good underwater.

So, what do you do?

Also, tech related question : You have mandatory decompression, but have to take care of the victim too...what do you do to prevent TWO injured divers?

 

[shortdivemedic]

There are just some things you can't deal with underwater and that is one in my opinion. I think the best thing to do is get out of the water as soon as possible and provide what treatment you can until help arrives. I think the whole trying to provide to much medical care while in the water is probably not in the best interest of the patient, heck even in the real world of EMS we find ourselves having to move a patient to a safe enviroment where we can provide good quality medical care. Diving is a sport that comes with risk ,like other activites we enjoy off the beaten path and with that come risk of not having good quality medical care available in a timely manner.

Just my opinion of course
Cheers
Michael

 

[KD8NPB]

There are just some things you can't deal with underwater and that is one in my opinion. I think the best thing to do is get out of the water as soon as possible and provide what treatment you can until help arrives. I think the whole trying to provide to much medical care while in the water is probably not in the best interest of the patient, heck even in the real world of EMS we find ourselves having to move a patient to a safe enviroment where we can provide good quality medical care. Diving is a sport that comes with risk ,like other activites we enjoy off the beaten path and with that come risk of not having good quality medical care available in a timely manner.

Just my opinion of course
Cheers
Michael

I completely agree.

These questions are with substance to them : I'm formulating an emergency plan for my area.

I'm trying to figure out what is the best equipment/training within my ability in which to ensure survival of the victim.

I have already called around and collected infromation from the hospitals.

There are two hyperbarics near me capable of emergency care.

One is in South Bend (Memorial Hospital), the other is in Battle Creek (Bronson Hospital). Battle Creek is ideal, as their staff has coordinated with Sub-Aquatic Sports to maximize training in response to diver related injuries.

Response time for Bronson is 8 minutes off the pad, 15 minutes travel to South Haven or 18 minutes travel to Lakeland Hospital in St. Joseph. They require 100' square of clearance to land the helicopter. The Fire Department handles the landing through incident command system. They are capable of landing at either St. Joseph or South Haven's Coast Guard stations, as both have sufficient space, lighting, and properly marked wires.

DAN specifies that O2 systems need to deliver around 15l/min to properly debubble the bloodstream. Additional assistance via paramedic or fire dept. should be on scene within 15-20 minutes, including boat travel time to the shore. So all in all, a Jumbo D cylinder should provide enough O2 to safely transport a victim. I think it would be best for me to learn some advanced airway management, such as intubation techniques and how to use a BVM in conjunction with O2... but at the same time, I'm not looking to go through the amount of training required for an EMT-B.

 

[TSandM]

If the victim is in severe laryngospasm, you will be unable to intubate them. You can sometimes break laryngospasm with positive pressure ventilation, but no, you can't safely do that with a regulator. If the exhaust valve is unobstructed, you cannot develop enough positive pressure, and if you obstruct the exhaust valve, you run the risk of blowing someone's lung.

Severe laryngospasm underwater is a horrible situation, because the victim cannot breathe; you cannot breathe for him, and you cannot bring him to the surface safely. In some cases, as with my friend Bob Bailey's terrifying experience in the Devil's system at Ginnie Springs, the spasm will resolve before the victim loses consciousness. In other cases, it won't. Unless you see bubbles come out of the victim, it is not safe to take them to the surface, although if they lose consciousness, I would probably do it rather than watch them die underwater. If you have a deco obligation, it is the same as any other life-threatening emergency in that state -- you have to weigh the likelihood of your own injury or death against the likelihood of saving your buddy, and decide just how much deco you are willing to blow off. This is one of the things that people who start doing a little "recreational deco" often haven't thought about.

 

[shortdivemedic]

Kudos to you in putting together some type of plan If more people planned ahead there might be some preventable deaths in diving. And TSand M explained that very well and there is not much you can do for them.
With regards to your planning I would just make some suggestions
1) Go talk to the EMS and Fire agencies in your area they might already have a plan in place for these type of emergencies. They truly are the professionals in pre planning for emergencies
2) Plan a bigger 02 tank Send me a PM with email and I will send you a chart which tells you how long the tanks will last at different uses
3) Plan for the worst case scenario such as multiple victims its always better to do that .
4) With regards to the airway understand there is no evidence that a patient with an advanced airway will do any better than a patient with a basic airways such as a pocket mask etc, so stay with what you train with and have available . The other thought is that the EMS or Fire dept will have the equipment and training to provide a patent airway to the patient .
5) Things always forgotten are the basics like how to contact the dispatch (Cell phone,radio etc) and the location needs to be as good as possible so maybe GPS coordinates or intersections .
6) Airmedical is great but not always able to respond all the time so back ups are a must ,same as for the local ambulances .

Just my opinion after YEARS of EMS
Cheers
Michael

 

[DeepSeaDan]

I posed this question:

http://www.scubaboard.com/forums/diving-medicine/281405-persistent-laryngospasm.html

some time ago & the responses were quite enlightening.

Regards,
DSD

 

[shortdivemedic]

DSD
Yes that was a great read and some interesting thoughts

Cheers
Michael

 

[DivemasterDennis]

Most basic rescue diver courses instruct to get the distressed/injured/unconscious diver to the surface as an initial action, without endangering the rescuer. ( see reference to deco situation above). There is a lot of information in this thread and the threads referenced in it that add to that basic rule for those who take the time to educate themselves. Once again, thank you scuba board.
DivemasterDennis