Do not ever say you are a rescue diver

[Ayisha]

...To avoid confusion, I would follow PADI advice and get diver on the hard surface ASAP if you are within 5 min.

Bold added.

That is not what PADI advocates.

...I think you would be better off on the boat/shore as soon as you can.
I suspect above is the reason for PADI recommendations.
Sure, two breaths at the beginning to see if you can ”wake“ them up. However, if it did not work, you better haul your victim to the boat/shore as soon as you can If you are within 5 min.

That's still not what PADI teaches. See upthread or below that PADI advice is the opposite of what you're attributing to PADI:

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.]

 

[BlueTrin]

I learned NOT to suck on my BC bladder long before the pandemic.
You actually disinfect your bladder? You are one in a million, I suspect.

I disinfect the ones with a removable dump valves every few months if I have dived them too. Also hang them without the dump my valve to dry for longer term storage …

Are we two in two millions?

 

[boulderjohn]

So the first thing to do would be to open the airway and give a breath. That at least gives some chance of survival, assuming there is still a pulse. If there is no pulse and no respirations when someone surfaces, do what you like, an AED is not likely to make any difference, no matter how quickly you get the victim to one.

Yes. Now you don't know they are pulseless, so you are giving them the benefit of the doubt and doing your best to salvage a bad situation. Surfacing diver who is actually pulseless and apneic is what is commonly called a "recovery"

The Rescue Course teaches that is almost impossible while performing a diving rescue to tell if the victim has a pulse, so you act on the assumption that there is a pulse. This contrasts with what the course teaches for a victim on land.

Now you go notify EMS first, then Compressions, and then rescue breaths. Why? because it has been shown to be more successful.

There is another reason for that sequence. When a person on land has stopped breathing, that person will almost certainly have no pulse, so there is no point of doing breathing first to a non-circulating victim. In contrast, for some reason, in drowning victims, a non-breathing person will have a pulse sometimes, so breaths can help in that circumstance. As mentioned in the last paragraph, the possibility that the drowning victim has a pulse is probably the only hope.

PADI's first aid course says exactly the same thing as the AHA and all other major organizations for dealing with a non-breathing victim on land. Its recommendations for a scuba drowning victim are different because the circumstances are different, and that difference is part of the course.

With a drowning victim, there is another benefit to the breaths. When breaths are attempted, they can initiate a vomiting response that revitalizes the victim. That is what happened in the only in-water scuba rescue I have hard described by someone I know. In that case, the victim was observed struggling on the surface, and then he went under. A rescuer (not on scuba) descended, pulled him back up, and brought him to the boat. On the boat, he was unresponsive, and they started compressions. When they give the first breaths, the victim vomited water, and he woke up.

 

[doctormike]

Well AHA will disagree with you. Drawing parallels to above the water CPR - what do you do if you find someone in the cardiopulmonary arrest? According to your line of thinking it is to give rescue breaths because of possibility of anoxic injury. That was recommendation 10 years ago. Now you go notify EMS first, then Compressions, and then rescue breaths. Why? because it has been shown to be more successful.
Furthermore, the newest guidelines say if you are not comfortable or incapable to give rescue breaths, continue with compressions along.
With that, I would rather get victim to 100% O2 and potential compressions sooner than delay by performing multiple rescue breaths.

I'll try one more time. What we are discussing in this thread has nothing to do with above water CPR.

If you want to insist that chest compressions take precedence over everything else, including oxygenation, because of what they teach in CPR for first responders on the surface, I'm not sure if I am explaining things correctly.

The AHA is not an organization that makes recommendations for underwater injuries.

 

[noserider]

The Rescue Course teaches that is almost impossible while performing a diving rescue to tell if the victim has a pulse, so you act on the assumption that there is a pulse. This contrasts with what the course teaches for a victim on land.

There is another reason for that sequence. When a person on land has stopped breathing, that person will almost certainly have no pulse, so there is no point of doing breathing first to a non-circulating victim. In contrast, for some reason, in drowning victims, a non-breathing person will have a pulse sometimes, so breaths can help in that circumstance. As mentioned in the last paragraph, the possibility that the drowning victim has a pulse is probably the only hope.

PADI's first aid course says exactly the same thing as the AHA and all other major organizations for dealing with a non-breathing victim on land. It's recommendations for a scuba drowning victim are different because the circumstances are different, and that difference is part of the course.

With a drowning victim, there is another benefit to the breaths. When breaths are attempted, they can initiate a vomiting response that revitalizes the victim. That is what happened in the only in-water scuba rescue I have hard described by someone I know. In that case, the victim was observed struggling on the surface, and then he went under. A rescuer (not on scuba) descended, pulled him back up, and brought him to the boat. On the boat, he was unresponsive, and they started compressions. When they give the first breaths, the victim vomited water, and he woke up.

Exactly - i was always told to get a breath or two in as soon as possible - not done a rescue course but remember being told that by lifeguards in the 70's or early 80's on a north cornish beach

 

[tursiops]

Exactly - i was always told to get a breath or two in as soon as possible - not done a rescue course but remember being told that by lifeguards in the 70's or early 80's on a north cornish beach

i wonder if we have learned anything in the last 40-50 years?

 

[doctormike]

i wonder if we have learned anything in the last 40-50 years?

I imagine that we learned that that is a good idea!

 

[kinoons]

Please see the attached https://www.nejm.org/doi/full/10.1056/NEJMra1013317 especially the sections on Rescue and In-Water Resuscitation and Initial Resuscitation on Land. It's ABC, perhaps with some extra breaths up front.

It’s a 10+ year old document. AHA has modified their guidelines for on land CPR for rescuers more recently. It would be interesting to get the authors take on drowning post AHA changes.

The reason AHA changed the recommendation is for adults sudden dysrhythmia is the likely cause of pulselessness, resulting in apnea as well. Restoring some form of circulation is the main goal, then you perform the rescue breaths. (Although if you perform compressions correctly two breaths is only about 20 seconds away, not several minutes)

Well AHA will disagree with you. Drawing parallels to above the water CPR - what do you do if you find someone in the cardiopulmonary arrest? According to your line of thinking it is to give rescue breaths because of possibility of anoxic injury. That was recommendation 10 years ago. Now you go notify EMS first, then Compressions, and then rescue breaths. Why? because it has been shown to be more successful.
Furthermore, the newest guidelines say if you are not comfortable or incapable to give rescue breaths, continue with compressions along.
With that, I would rather get victim to 100% O2 and potential compressions sooner than delay by performing multiple rescue breaths.

OTOH, as doctormike has pointed out, when diving that assumption has a reasonable chance of being incorrect. Then add in that performing compressions in the water isn’t happening, opening the airway as soon as possible on the surface and providing two breaths is a good move.

As also pointed out, since compressions in the water isn’t happening, checking for a pulse really doesn’t matter either; the patient is still unresponsive, so it’s an emergency, and you can’t do compressions, so the presence or lack of a pulse doesn’t matter. The only remaining reasonable interventions is getting to shore/boat as quickly as possible and providing the occasional rescue breath. I would agree with doctormike that two breaths every minute or so is reasonable for the situation as well.

 

[doctormike]

Exactly. And having been involved in the preparation of official recommendations from professional organizations, I will tell you that there is a lot of concern about the limits of applicability. Because you are putting the stamp of the organization's authority on the document, you want to be sure that it is only used in the situation for which it was designed.

One of the published indications for emergency thoracotomy is cardiorespiratory arrest, and this procedure has a survival rate of up to 60% in some series. Nevertheless, it is not appropriate for an unresponsive diver in the water. Context matters.

 

[Beau Holden]

I show my cave card and that is all. If someone needs help i will give it. If someone wants help I will give it. However I'm not there to babysit and if stupid presents its self, then its on its own.