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

[rongoodman]

If the person is in atral fibrillation (a shockable rhythm), every minute prior to shock loses 10% of the chance of bringing the heart.

You mean ventricular fibrillation.

 

[Griffo]

I did EFR and SSI rescue two weeks ago. The focus is certainly on hauling ass to shore / boat and starting compressions. SSI teach two rescue breaths and that's it if you can can them to shore in under 5 minutes. No further breaths in water, as it's difficult to do properly, ineffective , wastes time, and you are just as likely to push water into their lungs.
The EFR course was basically saying " just pump". Forget looking, listening, checking airways etc, just start pumping.
Hardest part was remembering the AB-CABS after a lifetime of DR-ABC.

Sent from my iPad using Tapatalk HD

 

[Kevrumbo]

I will echo what almost everyone else has said. In water CPR does not/cannot be done successfully. I learned CPR back in the 60's as a scout. High school and college water sports and teaching PADI Rescue class each quarter for nearly 10 years. You've got to have a hard surface to push against.

I like the tank valve tow for speed and safety. My students do the rescue drills taking the gear off and swimming with an unconscious diver and a dummy. This builds confidence and incorporates task loading with having to give rescue breaths every five seconds.

Never fails in every class the question gets asks wouldn't it be faster to simply swim the diver straight to the boat or shore. Absolutely. Why waste valuable minutes on something that is very marginal at best.

I also tell them that they could encounter a situation where gear removal is necessary hence the training.

Bullscat . . .!!!

In the water with a victim in full arrest . . .and especially for a friend or loved one you will try & do anything --even with only a 17% chance of ever regaining some range of sinus rhythm.

What about attempting modified chest thrusts --if you can-- as well as rescue breathing as you're towing the victim? (Modified chest thrusts from behind as in the modified Heimlich maneuver. . .)

What if you're downcurrent in a remote location with a victim in full arrest on the surface, and a skiff from a live aboard coming for rescue?

(You gotta try and do what you can do for as long as you can. . .)

 

[TSandM]

It's all about maximizing the efficacy of what you can do. If I'm floating way offshore, a long way from the boat, with an unconscious diver who isn't breathing, I'm going to try rescue breaths, and maybe I'd try some kind of Heimlich-type chest compression -- but I can tell you from having done CPR on a lot of people, some of whom were fully instrumented so that we could monitor the blood pressure and even the cardiac output created by what we were doing, that it takes GOOD compressions to move blood. You have to make a big difference in chest volume, and keep a good rhythm at a steady, fairly quick rate. I don't see that happening if you're holding someone to your chest and trying to "hug" them into circulation. Would I try it? Maybe . . . it would depend on where I was and what the circumstances were. But I certainly would not delay getting someone to a better situation for attempted resuscitation, in order to perform an intervention which is unlikely to be effective. This is my objection to doing rescue breaths while towing. Mouth-to-mouth is not terribly good ventilation, even when performed on dry land by a rescuer whose ONLY responsibility is to do that. It's far worse when you are trying to rear up over someone in the water.

I know other things are taught. But I have both medical training and over 20 years of experience in running resuscitations, and I'll go for what I think (and what there is SOME basis in evidence) is effective.

 

[GrimSleeper]

Most dive training agencies recommend that, if you are within five minutes of a hard surface where effective CPR can be performed, get there as fast as possible, but if it's going to take more than five minutes then in-water rescue breaths should be attempted. Nobody, so far as I know, recommends attempting any form of CPR in-water, due to the difficulties of establishing whether or not there is circulation, the low probability of success, and the high probability of drowning the victim (assuming that hasn't already happened).

To be cynical, if it's going to take more than five minutes to get the victim out of the water, in my opinion the odds are stacked pretty heavily against them making it alive, so the rescue breathing is really just so the rescuer can feel like they're doing something that might help. Mind you, I don't disagree with Kevrumbo when he says you have to try to do what you can for as long as you can, so I'd still be breathing away until we eventually got to the boat/shore.

 

[haumana ronin]

Is there some kind of mechanical strap compression device available for when you are more than 5 min from a hard surface? Maybe powered off of your tank. There is a lot of mechanical energy in a scuba tank. :dork:

:zen:

 

[Kevrumbo]

It's all about maximizing the efficacy of what you can do. If I'm floating way offshore, a long way from the boat, with an unconscious diver who isn't breathing, I'm going to try rescue breaths, and maybe I'd try some kind of Heimlich-type chest compression -- but I can tell you from having done CPR on a lot of people, some of whom were fully instrumented so that we could monitor the blood pressure and even the cardiac output created by what we were doing, that it takes GOOD compressions to move blood. You have to make a big difference in chest volume, and keep a good rhythm at a steady, fairly quick rate. I don't see that happening if you're holding someone to your chest and trying to "hug" them into circulation. Would I try it? Maybe . . . it would depend on where I was and what the circumstances were. But I certainly would not delay getting someone to a better situation for attempted resuscitation, in order to perform an intervention which is unlikely to be effective. This is my objection to doing rescue breaths while towing. Mouth-to-mouth is not terribly good ventilation, even when performed on dry land by a rescuer whose ONLY responsibility is to do that. It's far worse when you are trying to rear up over someone in the water.

I know other things are taught. But I have both medical training and over 20 years of experience in running resuscitations, and I'll go for what I think (and what there is SOME basis in evidence) is effective.

It's also about being practical, sometimes "in the field" away from a clinical setting Lynne (i.e. away from an Emergency Department of a major hospital) such as what a group of first responders would encounter in a worst case scenario in a locale such as Palau --in the middle of blue water ocean; drifting away from a coral atoll/land; recovery by dive-op skiff in a few minutes but with transport back to an Advanced Life Support Clinic/Hospital more than an hour away. I can't in good conscious resign to inaction; I can't legally elect to do nothing if I'm still reasonably able to provide aid; And I can't halt resuscitation efforts in the field unless there happens to be a Physician "out there in the field" to declare the victim dead.

It's a grim scenario to be sure: on the surface, floating away with a full arrest victim . . .I'll be trying --and hopefully with other surfaced divers in my group as a team-- modified Chest Compressions/modified Heimlich along with careful Regulator ventilations (seal lips around mouthpiece/pinch nose and gently purge), while awaiting recovery.

 

[g1138]

even on a rigid backboard, I am guessing that every compression would result in the victim being pushed underwater, and if they are, then they are not getting sufficient compressions.

Yes this is true. There was technique to it.

When I did my 3 rounds of Lifeguard Training only 1 agency taught in water CPR, which was specific to the water park I was working at, at the time.
We used a heavy wooden backboard with straps and a head restraint. The victim was strapped down from head to toe. We wouldn't begin in-water CPR until the victim was securely and fully strapped in. Then we would have one LG at the head, two at the side.

Side or head LG would perform rescue breaths, and the final LG at the side would perform 1-handed chest compressions with one hand under the board and the other pushing down. You had the be standing with water below your waist for this to work. If you weren't you moved on until you could.

The only time we wouldn't just pull the victim out before starting CPR was when we were in the lazy stream river/pool, which besides the exits was surrounded by bushes. That was the only reason we would even consider in-water CPR.

 

[rongoodman]

Is there some kind of mechanical strap compression device available for when you are more than 5 min from a hard surface? Maybe powered off of your tank. There is a lot of mechanical energy in a scuba tank.

The Zoll AutoPulse costs more than $10K--not something you want to drop in the ocean.

 

[haumana ronin]

The Zoll AutoPulse costs more than $10K--not something you want to drop in the ocean.

Try clipping that to a D-ring...

:zen: