Coast Guard Triage Question (U-869)

[rawls]

First, as far as I know, and correct me if I'm wrong, the Coast Gaurd will not administer O2 without a prescription. At that point in time, O2 therapy was not well known, either.

Ok...Most places do not require a prescription for O2 therapy in diver emergencies. Some places may require you be trained in O2 administration. A Coast Guard Rescue Swimmer can administer O2 anytime he or she deems appropriate...
Reasearch into O2 therapy was going on long before the Rouses died...I did a 2 minute search on Rubicon and came up with an example...The Basis for Drug Therapy in Decompression Sickness. A. A Bove, Undersea Biomedical Research, Vol. 9, No 2, 1982...Emphasis 1982

the chamber has to be able to take the diver back to theoretical depth, the one used was not capable of this (again I may be incorrect).

Yep...Incorrect...Recompression has established protocols for treating DCS and AGE. For usual DCS cases the chamber is pressurized to around 60 feet. Doctors may take the victim as deep as 165 feet if it is deemed this amount of pressure will improve outcome from a cerebral event from AGE. The chamber Chrissy was placed in was totally adequate to handle his treatment requirements.

The son supposedly ran out of air, yet the boat or swim platform cracked his maniflod- and huge hissing of air was released.

There was no mention that they were completely out of air in either SD or Last Dive. In addition there is the topic of reduced ambient pressure. So, not unusual there was a hissing sound once the manifold fractured.

In SD, Chatterbox immediately knows that Kooler's CPR card has expired- think about it, do you know when your buddy's card is set to expire, and even if you do, would you stop them from giving CPR?

First...The CPR issue was written in Last Dive, not SD. Second... "Chatterbox" as you call him did not automatically know "Kooler's" card had expired...He asked him. IMHO I don't think it is very unusual at all, in this circumstance, when "Kooler" said he would take over, that "Chatterbox" would ask him if he was current. You can EASILY be sued in civil court for something like this and "Chatterbox" most likely knew it. It didn't take alot of thought to see "potential lawsuit" written all over this event. Good Samaritan laws do not prevent the bringing of a law suit. If it was my friend and I was in this situation and knew he wasn't current in CPR then, hell yeah...I would stop him. Lawyers would have a field day with "Kooler" if they knew he gave CPR without current certification...Mucho dollars.

Now, on to your question of what the Coast Gaurd does- they will grab as many as they can. Unless there is a doctor able to pronounce someone dead

Agreed...That's the $100,000 question. Does the rescue swimmer have the ability to pronounce death. If he or she doesn't then the question is moot because the Coast Guard would have to take both...They would have to take both of them. Which in the end they did. It all boils down to what Chatterton said. Whichever version, the outcome was the same...Both were taken.

I do agree that it would be good to hear from a USCG person about the policy because I looked and looked and couldn't find it.

 

[northen diver]

A few things came into play as to their deaths, let alone the whole book debate. First, as far as I know, and correct me if I am wrong, the Coast Gaurd will not administer O2 without a prescription. At that point in time, O2 therapy was not well known, either. Second, the chamber has to be able to take the diver back to theoretical depth, the one used was not capable of this (again I may be incorrect). Now, onto the book. The son supposedly ran out of air, yet the boat or swim platform cracked his maniflod- and huge hissing of air was released. In SD, Chatterbox immediately knows that Kooler's CPR card has expired- think about it, do you know when your buddy's card is set to expire, and even if you do, would you stop them from giving CPR? There are good samaratin laws (sp), that protect you....Chatterbox is also said to have argued with the rescue swimmer- from all accounts (including appearently a video taken on scene) this is not true. I have met some of the people involved, and all seem nice enough, leaving me to believe that the author is the problem in this (Kurson). His other books include nothing on diving, and the entire book portrays it as a dangerous sport that "constantly kills its young." Hmmm, when I help students through training, or am working on a wreck boat, I am always leary of which one is not coming back. Yeah....we lose 'em all the time....and this includes technical diving....However, when I see a morbidly obese diver get on, even when he has thousands of dives, I do tend to get nervous. (My friends knw exactly whom I am thinking of)...
Now, on to your question of what the Coast Gaurd does- they will grab as many as they can. Unless there is a doctor able to pronounce someone dead, it is like an ambulance- you always are pronounced dead on arrival..... Most boats do not have deaths on them, even when diving the Doria. A LOT of people do get bent however, or run the risk of it, so as a DM, be prepared with O2, knowledge of in water recompression, keep your skills up, and think through your emergency plans. In just the past season, my buddies and I have seen an increase in divers needing the above. Just to end this I'll give a few examples- guy got onboard, computer screaming a deco violation, and his arguement was "I still have plenty of air." Another got onboard, complained of a headache, and we later found out that he had gone from 60 ftsw to the surface in UNDER 30 seconds. These were both "advanced OW" divers- and neither was PADI, before anyone starts bashing agencies. Enough of my ranting, hope all this helps you, and like I said, I am not positive on the O2 thing, so maybe someone can help me on that.
Good luck on the IDC goal!
-J

I have not read this book. But the USCG AST's (resuce swimmers) are NREMT-B's. A few of the air stations will have EMT-P's, but a very few. The USCG DOES carry O2 on all of thier helo's and does admin O2. It is part of thier medical bag. They use two different types of helo's. The UH 60's (Army's version of the Blackhawk) and the UH 65 (the Dolphin) The UH 65 has a much smaller payload, so that limits the number of patients. The USCG does have a set of protocals as do the counties and cities EMS services does. Each resuce can become unique to these guys since they operate in such a wide range of senerios. If you really want to know about the protocals, go to Benefiting the US Army, US Navy, US Air Force, Marine Corps, Coast Guard - Military.com and search for the USCG AST forum and the AST's will be able to discuss thier protocals with you. They wont however discuss too much of particluars with actual cases because of HIPPA laws.

 

[Charlie99]

Does the rescue swimmer have the ability to pronounce death. If he or she doesn't then the question is moot because the Coast Guard would have to take both...They would have to take both of them. Which in the end they did. It all boils down to what Chatterton said. Whichever version, the outcome was the same...Both were taken.

I do agree that it would be good to hear from a USCG person about the policy because I looked and looked and couldn't find it.

The Coast Guard expects non-doctors to be able to decide when someone is dead, and expects them to be able to do at least a preliminary guess at cause of death. Those two requirements, along with preserving a dead body are part of the "Medical Person In Charge" exam that is part of the requirements for CG merchant marine watchstanding qualifications for masters and chief engineers. (This is for larger ships, not the 100 ton license common on dive boats)

I don't have personal knowledge, but have been told by people in the commercial fishing industry in SE Mass. that the CG will do medivacs, but if you tell them the victim is dead, they will call the helo back to base and tell you to put the body on ice and come on back into port. In most of these cases, the fish boat captain doesn't have any sort of medical training or qualification, and the CG just relies upon basic common sense and judgement as to whether someone is alive or dead.

 

[dashark]

You do not need a prescription to administer o2, just the proper training. The Coast Guard has o2 on board, and the rescue swimmers are trained to use it.
As far as pronouncing. In California there needs to be a Dr, to pronounce,but, not to determine death. That is a Paramedic skill used for signs of obvious death (which neither of these divers presented anyhow).
however, triage in relation to time , manpower, fuel, and weight concerns overides all of this. Either scenario of leaving one diver or taking both could be easily justified depending on the conditions.
The important thing for rescues such as this is that someone take charge, make the call, and everyone goes in the same direction from there.
As far as aircraft, I fly with the coast guard in the dolphin. I could never work up 2 patients at once in the back of there effectively. i would be interested to know which helo they were using.

 

[northen diver]

The Coast Guard expects non-doctors to be able to decide when someone is dead, and expects them to be able to do at least a preliminary guess at cause of death. Those two requirements, along with preserving a dead body are part of the "Medical Person In Charge" exam that is part of the requirements for CG merchant marine watchstanding qualifications for masters and chief engineers. (This is for larger ships, not the 100 ton license common on dive boats)

I don't have personal knowledge, but have been told by people in the commercial fishing industry in SE Mass. that the CG will do medivacs, but if you tell them the victim is dead, they will call the helo back to base and tell you to put the body on ice and come on back into port. In most of these cases, the fish boat captain doesn't have any sort of medical training or qualification, and the CG just relies upon basic common sense and judgement as to whether someone is alive or dead.

The USCG acts upon protocals such as our cities and counties EMS does. Some of the basic common sense "cease effort protocals" are: Incinerations, decapitations, rigor, decomps, submersion for 1 hour or more in warm waters, DNRs, cold/stiff body in warm enviroments.
The USCG air stations has medical officers as thier medical commands. Some of the stations will also act within the local protocals if they are within the US territory. For example, in Ohio, under the Ohio Revised Codes, only a licensed medical physican call call death. But a EMT P, EMT A, RN can assist in determining death (cease efforts).

 

[northen diver]

I am a 12 year paramedic at a fire station that provides Paramedic services to the Coast Guard when needed. I have been flying with them when needed for over 6 years now.
As with any first responder, triage is the name of the game. If you have ever found yourself in a situation like this, it is logical.
I have personally had to triage patients while aboard a coast guard helicopter and return for the other patient later. Fuel and weight considerations are a big concern when considering if you can handle 2 patients. Not to mention manpower and space. It is pretty tight inside their helicopters.
Weather or not this is their SOP , I cannot say. I assume that triage is pretty much universal for anyone who is involved in rescue operations. I have seen no indication that the crews I have flown with for the past 6 years operate any differently.
Although I have read both books, I cannot remember exactly how the rescue went down.
Maybe we can scare up some coast guard personel on this site for more info.
Hope this helps.....

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[dashark]

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come again?

 

[northen diver]

come again?

PM inbounding...........

 

[rawls]

Thanks for the replies from northern Diver down to...well...northern diver The info you all provided answered alot of questions and at the same time brought more...So...USCG rescue swimmers can "determine" death...as opposed to officially pronouncing it and make the call whether or not to take the deceased diver on the ride back. And it also seems that from what you guys said, that it's basically an educated judgement call as to the triage parameters...in general. In other words there is gray area to work with. IMHO these people should be given the ability to make those calls. Now the question remains as to why the decision was made to take both Chris and Chrissy instead of leaving Chris? And as Charlie said it is sometimes a judgement call...In other words the CG gives some degree of credence to someone who says...hey...the person is deceased. Hell...It has now piqued my interest even more as to why the triage was carried out in the manner it was. I go diving with John on occasion during certain events and I have not asked him questions regarding the book...and he doesn't talk about the book unless someone asks him a question. I may have to break down and ask him about this...It is one not only myself, but alot of people have had for quite awhile.

 

[highlandfarmwv]

Just because someone's CPR (BLS) card has expired does not mean they forgot how to perform it. Even in our hospital, many staff members' cards are expired for a few months until their schedule allows recertification.