Efficacy of providing rescue breaths?

[Tigerman]

My last EFR brushup (we have then twice a year at work) they did state that CPR had been changed to exclude breaths, WITH THE EXCEPTION OF SUSPECTED DROWNING. Which means if youre on the beach or on a boat youre likely to be well served to still know how to provide breaths..

 

[g1138]

Seefourdc, You can extend the neck better without a hard surface. Just sit in your chair, let your neck muscle loose, and let your head fall back. Be careful not to snap your neck while doing this. You'll get plenty of extension without a hard surface, that isn't an issue in the water at all. There may be an issue of over extension in fact, because the head tends to slack and sink if you're holding the victims torso afloat and horizontal. So supporting the head is my advice when transporting in the water.

The issue has more to do with maintaining a stable reference between you and the victim when giving rescue breaths in moving water.

You're correct in that if you don't see the incident happen with an unconscious diver, you can usually assume the heart has stopped and if so rescue breaths are ineffective.
I still disagree in a land setting that rescue breaths aren't needed at all. For prolonged CPR you need to give a source of O2 to be circulated by your compressions. That's where rescue breathing comes into play, it is equally as important as chest compressions if you're going into a prolonged CPR procedure.

Like I said, it's still a gray area for me. I can still keep pace and give simulated rescue breaths in practice. So if I have a long swim to shore, I'll give rescue breaths, just because it doesn't hamper me and because it makes me feel better. YMMV.

 

[DaleC]

I am quite proficient providing breathes and compressions and would do so no matter what the current thinking is. It's far better to pick a method and get good at it than to keep switching every couple of years based on the whimsy of some researchers. After a couple of decades I've seen the standards go back and forth and back again.

I would have to make a judgement call as to in-water Tx however, as it would be substandard at best. If an exit were close I might defer, if it were more than a couple of minutes for a witnessed event I would begin in water.

 

[TSandM]

The typical pulseless collapse on land is cardiac or neurologic. Up until the moment of collapse, the victim was breathing, and the lungs are working normally. That is quite different from any cardiac arrest suffered in or under the water, and the new guidelines for compression-only resuscitation exclude drowning.

Gene's committee paper concluded, on the basis of a study of lifeguards, that rescue breaths were reasonable. Although I respect and applaud the work done by the committee, I really have to be dubious about this conclusion. Lay rescuers, with no training in artificial respiration, who are in scuba gear to boot, I think are highly unlikely to provide any kind of effective rescue breathing. I maintain my own position, which is that several rescue breaths are reasonable upon surfacing the victim, in case stimulation of the airway can induce spontaneous respiration. If two or three rescue breaths doesn't get the job done, you are most likely dealing with someone in cardiac arrest as well, or seriously neurologically impaired, and getting that person to where secondary care is available becomes a critical objective. And I don't believe that most lay rescuers in scuba gear would be as little delayed as the study suggests the lifeguards were.

 

[USFpsychDiver]

I've taken both PADI Rescue and Red Cross 1st aid/CPR in the past 6 months. Instructors in both classes acknowledged the current state of flux and inconsistency between agencies in CPR breath administration. Both PADI and Red Cross trained for administration of breaths at varying intervals, PADI while swimming the victim to boat or shore, Red Cross at intervals between chest compressions (although less frequently than in the past). Instructors in both courses said that it's ultimately up to the judgement of the responder how to proceed.

My judgement is to administer a couple of quick breaths, then book to the nearest hard surface: boat or shore. This is based on:

1. Breaths do no good if there's no heart beat.
2. I cannot assess presence or absence of heart beat in the water.
3. There is irreversible brain damage within minutes without oxygen.
4. Accurate assessment and treatment can only be performed on a hard surface.
5. I cannot swim the victim to that hard surface nearly as quickly if I'm administering rescue breaths than if I'm just swimming.

So my primary goal is to get the victim to the shore or boat where effective assessment and treatment can be provided. The couple of breaths before starting the swim I consider part of the initial in-water evaluation of the victim's condition -- just in case there is a pulse and the victim might respond positively to air being forced in to the respiratory system.

As far as I know this is not the recommended procedure of any training agency and I do not present it as such; it is simply my judgement (and one I have never, thankfully, had to use).

 

[TSandM]

One of the interesting things about the lifeguard study was how little the lifeguards were delayed in their transport by doing rescue breaths. But I would really like to see this study replicated with divers, who of necessity move more slowly to begin with, and for whom getting up out of the water far enough to deliver a breath is comparatively more difficult, unless they jettison their own equipment.

 

[theduckguru]

This is pretty simple stuff. You make a best guess decision. You got less than 7 minutes. If the boat, shore, or platform is within that time, go for it. Otherwise rescue breaths might be all you got.

I regularly provide ACLS at my job to patients (Multiple times a week) and I've been thinking about the AHA changing their guidelines for non-healthcare providers to no longer providing rescue breaths in an out of hospital code situation. It got me to thinking... doesn't it seem like bad practice to attempt to provide rescue breaths to a diver found unresponsive while towing them? If you look at the reasons they stopped teaching rescue breaths it makes even less sense to me to attempt to provide rescue breaths during an in water rescue situation. (You can't see chest rise effectively, it's harder to get head tilt, and the biggest one is if they are already in cardiac arrest you are wasting valuable time that decreases chances they will survive.)

I bring this up because even as someone who practices these skills numerous times a week I don't feel like the time used attempting to provide a rescue breath until the patient is on a stable surface would be time used valuably.

Thoughts?

 

[JohnN]

The typical pulseless collapse on land is cardiac or neurologic. Up until the moment of collapse, the victim was breathing, and the lungs are working normally. That is quite different from any cardiac arrest suffered in or under the water, and the new guidelines for compression-only resuscitation exclude drowning.

Gene's committee paper concluded, on the basis of a study of lifeguards, that rescue breaths were reasonable. Although I respect and applaud the work done by the committee, I really have to be dubious about this conclusion. Lay rescuers, with no training in artificial respiration, who are in scuba gear to boot, I think are highly unlikely to provide any kind of effective rescue breathing. I maintain my own position, which is that several rescue breaths are reasonable upon surfacing the victim, in case stimulation of the airway can induce spontaneous respiration. If two or three rescue breaths doesn't get the job done, you are most likely dealing with someone in cardiac arrest as well, or seriously neurologically impaired, and getting that person to where secondary care is available becomes a critical objective. And I don't believe that most lay rescuers in scuba gear would be as little delayed as the study suggests the lifeguards were.

Thanks Lynn,

But shouldn't you also be arguing for an AED on every dive boat? My understanding is that if the person has gone into cardiac arrest, no amount of chest compressions is going to do anything to get the heart started, and at best you are only buying time? AED's used to be expensive, no longer is this the case.

The mis-perceptions I've seen about AED(s) and diving are interesting. The last excuse I heard about why one was in the dive shop and not on the boat was that "water makes it too dangerous".

 

[Oldbear]

Approach the victim as if they are already dead...this works no land or aquatic environments. Then try and use what techniques you have for a given situation to "revive" them. It might mean two quick rescue breaths and swimming as fast as you can back to shore or the boat. It might mean provide rescue breaths every five seconds until help arrives...if it does. It might mean providing CPR in a restaurant until EMS relieves you.

I think it is important, at least to me, to keep up on as many different techniques that I possible can so when a situation arises, hopefully, I will remember the proper technique/training for that situation. So far in the last three months I have taken three courses and all of them have a little different take on things.

Knock on wood...so far I have never had to employ any of the different techniques yet and I hope I never will.

 

[TSandM]

I can't argue for an AED on every dive boat, any more than I can argue for one on every bus, or in every grocery store. Medical emergencies can occur anywhere. Dive boats carry fairly small numbers of people, most of whom are of a younger demographic and reasonably fit (in other words, they don't have congestive heart failure or known severe coronary artery disease). I don't know how many accidents a typical dive boat sees in a year, where an AED would even have been pertinent, but I suspect it's less than one for the average boat. It's hard to recommend the expenditure of a couple of thousand dollars to deal with a fairly rare occurrence, where you aren't even sure the device will make a difference.