Do not ever say you are a rescue diver

[Edward3c]

The Course Director who taught my Instructor Developer Course said he had once gone to a required session for Course Directors, and they all had to do the main rescue scenario from the course--bring an unconscious diver to the surface and tow the victim to shore/boat while giving uninterrupted rescue breaths, removing all the victim's equipment, and removing all your own equipment as you go. All those Course Directors had had to teach that skill many times in their careers, but for most of them it had been a while. He said they struggled to do it. Some would have failed if they had been doing it for the beginning instructor exam.

I have never heard of a situation where that exact scenario has actually happened. I have challenged people over the years to provide an example, and when I do, people triumphantly provide examples of divers who were rescued with different circumstances, but I have never seen that exact scenario played out, successfully or unsuccessfully.

It’s not that the sequence taught, it’s the one a rescuer will be presented with. Rescue is part of our core driver training:
• An Ocean Diver (OD) will be taught how to recover a diver from 6m, provide buoyancy, and call for assistance.
• A Sports Diver (SD) will be taught how to recover a diver from 10m, provide buoyancy, give in-water rescue breaths (RB) for 1 minute, then tow 25m without additional RB. Then with assistance de-kit the casualty. remove from water, provide CPR with RB (using a training AED), then place into the recovery position.
• A Dive Leader (DL) will go through the SD but starting at 15m and with O2. In addition, they have to manage a number of rescue simulations.
• An Advanced Diver (AD) will go through the DL but starting at 20m. They also get presented with a rescue scenario (during normal diving activities) where they need to take charge and manage the situation. I often hit them with the scenario as their getting out of the water or preparing to go in on their own dive, when another pair from the group raise the alarm.

We make it clear the rescue skills taught are just a toolset, if they ever had to do it for real the situation will be unique.

 

[Dody]

She is a natural while I am a cerebral. When we got started in diving, I was struggling with buoyancy control at shallow depth. I am ashamed to say that I destroyed some reef twice hitting some curved walls with my head not realizing I was ascending. She had no such issue. And she was always there for me, rushing and pulling me down. Fortunately, I got better after almost 200 dives in two years. However, I read all literature I can. About diving accidents, the way to prevent them,… I have read all DAN and BSAC incident reports of the last ten years. She did not. Past her AOW, she is just enjoying herself. It is not because I am a control freak that I will blame her.

She may have had or more likely, she was nervous and/or tired. It is a common thing for new divers to actually be holding air in their lungs despite believing that they have fully exhaled.

I believe that it would be a good thing for your wife to take some private lessons with an instructor and you NOT be around.

Are you sure that she enjoys diving or is she just doing this to please you?

She may have had or more likely, she was nervous and/or tired. It is a common thing for new divers to actually be holding air in their lungs despite believing that they have fully exhaled.

I believe that it would be a good thing for your wife to take some private lessons with an instructor and you NOT be around.

Are you sure that she enjoys diving or is she just doing this to please you?

She really enjoys it, loves sport waters and she would do scuba without me but you have a point. I have dived with other people while she has only dived with me. But she does not always trust me. Once, we faced a very strong current. I told her to follow me deep and close to the reef but she preferred following a dive guide who was behind us, having fun with the current. She followed him and ended up in trouble. Another time, her, me and a guide had to surface because we lost our way. I took a bearing, checked my wife SPG (100 bars) and told her that we should descend shallow instead of swimming at the surface. She refused until the maybe 21 years old guide said it was the good course of action. She later told me that she was not comfortable with me making “ life and death “ decisions. I told her that she should have other buddies but she wants to stick with me. Couple dynamics are probably beyond SB’s scope.

 

[Dody]

It would be better if she has her own dive vacation without Dody being around. Go on the same vacation but dive with different dive buddies or dive with different dive shops. I agree she needs to be away from the ever present macho man husband.

I am no macho. Maybe over protective but she always does whatever she wants. I agree with one thing. She should dive with other buddies and llearns her way.

 

[tursiops]

Sure. That's what they say. Well, that's what some say.

When they changed the rulings on this a decade or so ago, I went directly PADI headquarters and asked for clarification. I gave what I thought was a ridiculous scenario. I asked if you are 30 feet from the boat and pull up an unconscious diver, do you go through that scenario? Yes, I was told. Begin mouth to mouth and removing your and the victim's gear as you tow the diver slowly to the boat. I said that contradicts my understanding. I was told that if that contradicts my understanding, then my understanding was wrong.

The 2005 PADI Training Bulletin says:

Q Why do the new inwater resuscitation guidelines suggest that if I am more than five minutes from an exit, I should focus on getting the diver out of the water as quickly as possible — and discontinue ventilations for a nonbreathing diver that shows no reaction to ventilations?​

A If the diver is showing no signs of circulation (such as movement or any reaction at all), the diver is probably in cardiac arrest. If there is no blood circulation, ventilations aren’t going to help. You need to get the person out of the water and onto a surface where you can better evaluate the patient and provide CPR or use an AED, as necessary. Further in water respirations in this situation only delay getting the person out of the water. On the other hand, if the person is responding to inwater ventilations, you​

should continue them during the tow.​

The most recent Rescue Cue Cards say, in the final section on Inwater Rescue Breathing Guidelines:

6. If you have determined the diver is not breathing and you con get the victim to immediate assistance
[i.e. , the boat or shore), do so while giving 1 rescue breath every 5 seconds.
[Establishing an open airway and rescue breathing can be lifesaving. When respiratory arrest occurs, the heart, blood and lungs can continue to circulate oxygen to the brain and other vital organs. Cardiac arrest follows respiratory arrest at a variable but short interval.]
7. Evaluate circumstances [your ability, opportunities for assistance, environmental
conditions] while giving 1 rescue breathe every 5 seconds and proceed depending upon conditions.
A. If if appears you are less than 5 minutes from safety, tow the diver to safety while providing
rescue breaths. Get the diver out of the water, continue rescue breaths and perform a
circulation check. Begin CPR if necessary.
B. If if appears you more more than 5 minutes from safety, continue to ventilate while checking for
movement or other reaction to ventilations for l - 2 minutes.
l . If movement or reaction to rescue breaths is present, but no spontaneous breathing,
continue providing rescue breaths while towing to safety.
2. If movement or reaction to rescue breaths is absent, the diver is probably in cardiac
arrest. Discontinue rescue breaths and tow the victim to safety as quickly as possible,
exit the wafer, perform a circulation check and begin CPR if necessary. Resume rescue
breathing if circulation is present. [Note: The potential disodvontoge of giving rescue
breaths is that if the victim is already in cardiac arrest it may delay starting CPR. There
is limited research that suggests the advantages outweigh this potential disadvantage.]

 

[Blackcrusader]

I am no macho. Maybe over protective but she always does whatever she wants. I agree with one thing. She should dive with other buddies and llearns her way.

Yes Dody you are. You have said so yourself in previous threads.

 

[chillyinCanada]

Untrue. She is a natural while I am a cerebral. When we got started in diving, I was struggling with buoyancy control at shallow depth. I am ashamed to say that I destroyed some reef twice hitting some curved walls with my head not realizing I was ascending. She had no such issue. And she was always there for me, rushing and pulling me down. Fortunately, I got better after almost 200 dives in two years. However, I read all literature I can. About diving accidents, the way to prevent them,… I have read all DAN and BSAC incident reports of the last ten years. She did not. Past her AOW, she is just enjoying herself. It is not because I am a control freak that I will blame her.


She really enjoys it, loves sport waters and she would do scuba without me but you have a point. I have dived with other people while she has only dived with me. But she does not always trust me. Once, we faced a very strong current. I told her to follow me deep and close to the reef but she preferred following a dive guide who was behind us, having fun with the current. She followed him and ended up in trouble. Another time, her, me and a guide had to surface because we lost our way. I took a bearing, checked my wife SPG (100 bars) and told her that we should descend shallow instead of swimming at the surface. She refused until the maybe 21 years old guide said it was the good course of action. She later told me that she was not comfortable with me making “ life and death “ decisions. I told her that she should have other buddies but she wants to stick with me. Couple dynamics are probably beyond SB’s scope.

Fair enough.

She may also have been finning a bit as she attempted to descend. This unfortunate action works against the diver attempting to descend.

 

[doctormike]

The 2005 PADI Training Bulletin says:

Q Why do the new inwater resuscitation guidelines suggest that if I am more than five minutes from an exit, I should focus on getting the diver out of the water as quickly as possible — and discontinue ventilations for a nonbreathing diver that shows no reaction to ventilations?​

A If the diver is showing no signs of circulation (such as movement or any reaction at all), the diver is probably in cardiac arrest. If there is no blood circulation, ventilations aren’t going to help. You need to get the person out of the water and onto a surface where you can better evaluate the patient and provide CPR or use an AED, as necessary. Further in water respirations in this situation only delay getting the person out of the water. On the other hand, if the person is responding to inwater ventilations, you​

should continue them during the tow.​

The most recent Rescue Cue Cards say, in the final section on Inwater Rescue Breathing Guidelines:

6. If you have determined the diver is not breathing and you con get the victim to immediate assistance
[i.e. , the boat or shore), do so while giving 1 rescue breath every 5 seconds.
[Establishing an open airway and rescue breathing can be lifesaving. When respiratory arrest occurs, the heart, blood and lungs can continue to circulate oxygen to the brain and other vital organs. Cardiac arrest follows respiratory arrest at a variable but short interval.]
7. Evaluate circumstances [your ability, opportunities for assistance, environmental
conditions] while giving 1 rescue breathe every 5 seconds and proceed depending upon conditions.
A. If if appears you are less than 5 minutes from safety, tow the diver to safety while providing
rescue breaths. Get the diver out of the water, continue rescue breaths and perform a
circulation check. Begin CPR if necessary.
B. If if appears you more more than 5 minutes from safety, continue to ventilate while checking for
movement or other reaction to ventilations for l - 2 minutes.
l . If movement or reaction to rescue breaths is present, but no spontaneous breathing,
continue providing rescue breaths while towing to safety.
2. If movement or reaction to rescue breaths is absent, the diver is probably in cardiac
arrest. Discontinue rescue breaths and tow the victim to safety as quickly as possible,
exit the wafer, perform a circulation check and begin CPR if necessary. Resume rescue
breathing if circulation is present. [Note: The potential disodvontoge of giving rescue
breaths is that if the victim is already in cardiac arrest it may delay starting CPR. There
is limited research that suggests the advantages outweigh this potential disadvantage.]

I don't know about any of this. I'm just an earwax miner who occasionally does airway surgery. I will tell you this.

The idea that some random rescue diver is going to be able to distinguish between cardiac arrest, drowning, airway obstruction, respiratory arrest, IPE, post ictal state, etc... while floating on the surface of the water with an unconscious diver is a fantasy. And the idea that you have 5 freebie minutes where nothing is happening to the diver's brain so that you can take that time to get them to a better platform is also incorrect.

Airway, breathing, circulation. ABC. Note the order.

You obviously can't address circulatory problems in the water. Yeah, if you knew that the patient had an open airway and functional lungs with some breathable gas in those lungs, but they also had a shockable arrhythmia (VF or pulseless VT) and the boat was right there with an AED on board, sure, go for it. But that's never the case.

If it's not something shockable but the patient has had a cardiac arrest (presumably due to the respiratory arrest from the diving accident), even chest compressions are probably not going to do anything out in the field, far from an ER.

So the low hanging fruit is to open the airway and blow in some gas, even the EAN 16 that all of us exhale with every breath. Yeah, get them out of the water, don't spend a lot of time doing rescue breaths. You don't need to do that, even one breath may be enough to allow for oxygenation while you are towing them in. But if you can also get some gas in there, you might make the difference between survival and death.

Oh, and don't forget to ditch their weights and blow up their BC on the surface.

 

[boulderjohn]

The 2005 PADI Training Bulletin says:

Q Why do the new inwater resuscitation guidelines suggest that if I am more than five minutes from an exit, I should focus on getting the diver out of the water as quickly as possible — and discontinue ventilations for a nonbreathing diver that shows no reaction to ventilations?​

A If the diver is showing no signs of circulation (such as movement or any reaction at all), the diver is probably in cardiac arrest. If there is no blood circulation, ventilations aren’t going to help. You need to get the person out of the water and onto a surface where you can better evaluate the patient and provide CPR or use an AED, as necessary. Further in water respirations in this situation only delay getting the person out of the water. On the other hand, if the person is responding to inwater ventilations, you​

should continue them during the tow.​

The most recent Rescue Cue Cards say, in the final section on Inwater Rescue Breathing Guidelines:

6. If you have determined the diver is not breathing and you con get the victim to immediate assistance
[i.e. , the boat or shore), do so while giving 1 rescue breath every 5 seconds.
[Establishing an open airway and rescue breathing can be lifesaving. When respiratory arrest occurs, the heart, blood and lungs can continue to circulate oxygen to the brain and other vital organs. Cardiac arrest follows respiratory arrest at a variable but short interval.]
7. Evaluate circumstances [your ability, opportunities for assistance, environmental
conditions] while giving 1 rescue breathe every 5 seconds and proceed depending upon conditions.
A. If if appears you are less than 5 minutes from safety, tow the diver to safety while providing
rescue breaths. Get the diver out of the water, continue rescue breaths and perform a
circulation check. Begin CPR if necessary.
B. If if appears you more more than 5 minutes from safety, continue to ventilate while checking for
movement or other reaction to ventilations for l - 2 minutes.
l . If movement or reaction to rescue breaths is present, but no spontaneous breathing,
continue providing rescue breaths while towing to safety.
2. If movement or reaction to rescue breaths is absent, the diver is probably in cardiac
arrest. Discontinue rescue breaths and tow the victim to safety as quickly as possible,
exit the wafer, perform a circulation check and begin CPR if necessary. Resume rescue
breathing if circulation is present. [Note: The potential disodvontoge of giving rescue
breaths is that if the victim is already in cardiac arrest it may delay starting CPR. There
is limited research that suggests the advantages outweigh this potential disadvantage.]

That does not contradict what I was told in the scenario I gave in th conversation:

When they changed the rulings on this a decade or so ago, I went directly PADI headquarters and asked for clarification. I gave what I thought was a ridiculous scenario. I asked if you are 30 feet from the boat and pull up an unconscious diver, do you go through that scenario? Yes, I was told. Begin mouth to mouth and removing your and the victim's gear as you tow the diver slowly to the boat. I said that contradicts my understanding. I was told that if that contradicts my understanding, then my understanding was wrong.

 

[tursiops]

The idea that some random rescue diver is going to be able to distinguish between cardiac arrest, drowning, airway obstruction, respiratory arrest, IPE, post ictal state, etc... while floating on the surface of the water with an unconscious diver is a fantasy.

PADI agrees.

And the idea that you have 5 freebie minutes where nothing is happening to the diver's brain so that you can take that time to get them to a better platform is also incorrect.

PADI didn't say that.

Airway, breathing, circulation. ABC. Note the order.

PADI agrees.

You obviously can't address circulatory problems in the water.

PADI agrees.

So the low hanging fruit is to open the airway and blow in some gas, even the EAN 16 that all of us exhale with every breath. Yeah, get them out of the water, don't spend a lot of time doing rescue breaths. You don't need to do that, even one breath may be enough to allow for oxygenation while you are towing them in. But if you can also get some gas in there, you might make the difference between survival and death.

This is the judgement call that PADI offers.

You clearly don't like the guidance provided. How would you restate it so as to be clearer, easier to follow, less ambiguous?

 

[doctormike]

PADI agrees.

PADI didn't say that.

PADI agrees.

PADI agrees.

This is the judgement call that PADI offers.

You clearly don't like the guidance provided. How would you restate it so as to be clearer, easier to follow, less ambiguous?

Yeah, I wasn’t disagreeing with you or them. I was responding in general because there were other posts talking about how getting the victim to the boat was more important than anything else.

I wanted to stress a simple message that is far more likely to be recalled in an emergency than a complex training pathway. Open the airway and give a breath or two. The few seconds that takes away from water egress are definitely worth the trade off. So that’s my clear, simple recommendation. Complex emergency procedures are rarely remembered correctly, even by professionals with frequent recertification. That’s the reason why checklists are important (not applicable here).

Having watched many people desaturate in the OR during bronchoscopy, I can tell you that people with full lungs can hold a reasonable Sat for a minute or so once ventilation stops. But if ventilation stops from a point where oxygenation is marginal, the saturation drops like a rock.