Holding a panicked diver down

[dallaskincaid]

Attach kettle balls to the back of their BC?

 

[MXGratefulDiver]

I have read a few incidents of divers holding a panicked diver down to prevent them from DCS or a pulminary baratroma. I read about a few incidents on the Dan site about divers holding a panicked diver down and the diver drowned. I read of a recent incident where an instructor held a panicked student down and she suffered for it. If a panicked diver is out of air and racing for the surface it seems kind of stupid to hold them down to face the certainty of drowning over the possibility of DCS or a PB.

I can see many dangers with holding a panicked diver with air down. For one they may freak out and spit out there regulator and drown.

Is it ever a good idea to hold a panicked diver down?

Yes, I have ... once. I was doing a private OW class with a student who had showed no sign of any inclination to panic. He did fine in the pool. We got out into OW for his first dive and he seemed fine until I signaled for him to flood and clear his mask. As soon as water got inside his mask it was like a complete personality disorder ... classic symptoms. Mask off, reg out, and an almost immediate attempt to bolt. I grabbed ahold of his BCD D-ring, and seeing he was not exhaling I would not let him go. He was clawing and flailing as I was attempting to get a reg in his mouth. Finally I put my hand on his plexus and gave a push. I don't think it was enough to do anything except get an instinctive exhalation response from him ... but as soon as I saw bubbles we were out of there, and on the surface within maybe 3 to 4 seconds (we were doing all this in 20 feet of water). Once on the surface and I got his BCD inflated he went completely limp, took a deep breath, looked at me and said in a perfectly calm voice ... "I can't believe I just did that".

It was the scariest 10 seconds or so I've ever spent underwater ... but it turned out OK.

... Bob (Grateful Diver)

 

[Ayisha]

1) Make contact with the ascending diver's BCD.

May I say that safely catching a rapidly ascending diver can be harder than it seems? An instructor who is in direct care and control of a student may keep themselves in an optimum position to help a bolting student, but it doesn't always happen with buddies. I have caught a couple of rapidly ascending divers, but before I managed to, I thought I almost had them several times but they kept slipping out of my reach since they were going so fast. I kept trying though, since I was so close and eventually got them, but then had a slight headache myself after catching and slowing them down. In each case, I was right beside the diver when they took off, or just below them on a line that had to be held due to a swift current.

(One was in Cozumel 10 years ago, and was a diver who was only allowed to dive with leaders but somehow became my buddy that day. She made a buoyant ascent from 40 feet or so at the end of a 90 foot dive, she wasn't panicked. She dragged me to about 10 feet before I managed to deflate her BC and hold her at the safety stop. We both had headaches, but otherwise ok.)

If a diver is making a fast, but otherwise safe, ascent - then you should slow them (not stop them).

If a diver is making a breath-holding ascent, you need to stop them (and get them breathing, before continuing the ascent).

It's sometimes hard to know at that moment if they're holding their breath or not, depending on your position in relation to the victim. Especially if you're slightly below them and behind them.

(Four years ago, a diver who did not have enough training or experience to do a dive here in the St Lawrence river on the Vickery, which combines depth with a swift current, got a lung overexpansion injury and could not dive for the next 9 months. She was my buddy and for some unknown reason, she left the line that everyone was pulling themselves across the wreck with and went off the wreck where some tech divers were doing skills a bit deeper, looking comfortable at this point. I went with her, the current was strong and we were wasting gas and effort swimming against it, and I motioned her back to the line. Instead, she bolted diagonally to the up-line, working very hard, and then looking at me. I pulled myself along and then up the line at a reasonable speed, catching up with her. She went fast again, I caught her fins, got her to turn around and look, I signalled to slow down, and she bolted again. I caught her again and again, she even nodded, but took off again. She blew our deep stop, and I managed to hold her for only a few seconds there, and we did 3 minutes at 20 feet, rather than our planned 5 minutes. She eventually was ascending just slightly fast to the surface, however, she was holding her breath for some unknown reason. She was congested and felt her long-unheard-of asthma was acting up, causing discomfort after the dive, and was not administered oxygen. It persisted, she went to a dive medicine doctor, and was diagnosed with a lung over-expansion injury and got clearance to dive only shallow, easy dives 9 months later. Almost 4 years later, she has never been diving again. After my repeated attempts to catch up with her, I had a slight headache after, but otherwise ok.)

I know that you're a professional and have this all worked out, but in the spur of the moment, it's hard to catch an ascending diver's BC and to think to look at if they're holding their breath or not, as you're trying not to hurt yourself in the process of catching them and slowing them down.

 

[brnt999]

May I say that safely catching a rapidly ascending diver can be harder than it seems? An instructor who is in direct care and control of a student may keep themselves in an optimum position to help a bolting student, but it doesn't always happen with buddies. I have caught a couple of rapidly ascending divers, but before I managed to, I thought I almost had them several times but they kept slipping out of my reach since they were going so fast. I kept trying though, since I was so close and eventually got them, but then had a slight headache myself after catching and slowing them down. In each case, I was right beside the diver when they took off, or just below them on a line that had to be held due to a swift current.

So how do you know--in the seconds you have to make a decision- if the rapidly ascending diver has air in their tank or not? Or does it make a differance?

(One was in Cozumel 10 years ago, and was a diver who was only allowed to dive with leaders but somehow became my buddy that day. She made a buoyant ascent from 40 feet or so at the end of a 90 foot dive, she wasn't panicked. She dragged me to about 10 feet before I managed to deflate her BC and hold her at the safety stop. We both had headaches, but otherwise ok.)



It's sometimes hard to know at that moment if they're holding their breath or not, depending on your position in relation to the victim. Especially if you're slightly below them and behind them.

(Four years ago, a diver who did not have enough training or experience to do a dive here in the St Lawrence river on the Vickery, which combines depth with a swift current, got a lung overexpansion injury and could not dive for the next 9 months. She was my buddy and for some unknown reason, she left the line that everyone was pulling themselves across the wreck with and went off the wreck where some tech divers were doing skills a bit deeper, looking comfortable at this point. I went with her, the current was strong and we were wasting gas and effort swimming against it, and I motioned her back to the line. Instead, she bolted diagonally to the up-line, working very hard, and then looking at me. I pulled myself along and then up the line at a reasonable speed, catching up with her. She went fast again, I caught her fins, got her to turn around and look, I signalled to slow down, and she bolted again. I caught her again and again, she even nodded, but took off again. She blew our deep stop, and I managed to hold her for only a few seconds there, and we did 3 minutes at 20 feet, rather than our planned 5 minutes. She eventually was ascending just slightly fast to the surface, however, she was holding her breath for some unknown reason. She was congested and felt her long-unheard-of asthma was acting up, causing discomfort after the dive, and was not administered oxygen. It persisted, she went to a dive medicine doctor, and was diagnosed with a lung over-expansion injury and got clearance to dive only shallow, easy dives 9 months later. Almost 4 years later, she has never been diving again. After my repeated attempts to catch up with her, I had a slight headache after, but otherwise ok.)

I know that you're a professional and have this all worked out, but in the spur of the moment, it's hard to catch an ascending diver's BC and to think to look at if they're holding their breath or not, as you're trying not to hurt yourself in the process of catching them and slowing them down.

So how can you be certain--in the seconds you have to make a decision- if the rapidly ascending diver has air in their tank or not? Or does it make a differance?

 

[Ayisha]

You've got to catch them first to know that. IMHO, that's not always easy to do, especially with certified divers, because you have to figure out if they are in control of their situation or not first, which loses a couple of seconds. With a student, you would probably first assume that they are not in control.

 

[Tigerman]

This is basically what happened in another thread: http://www.scubaboard.com/forums/accidents-incidents/449366-write-up-near-death-monterey.html

Now that IS an absolutely horrific event, but its not quite the same.
You pretty much have someone denying a diver (although in training) the use of an alternate air source, without even making sure the one she has to be working. (Amongst a whole lot of other issues)

Why do you choose hours when minutes will do the job nicely. I have to wonder why you choose to describe this as "hold them down" rather than "assist them to avoid the hazard". I feel it depicts a dangerous attitude. My wife's first scuba instructor told the class on the first day that all problems were solvable UW and he would stand on anybody's tank and hold them down if they attempt to surface. He put the OW class off badly enough that he was replaced before the next class. It is not the act as much as the attitude that I find alarming.

I call it "hold them down" because thats exactly what you do for some short ammount of time while making sure the ascent will be safe.
I could just call it "rescuing them" but thats not very precise with regards to what might need to be done to achieve it?

 

[TSandM]

You asked the question as to what the incidence of AGE is in divers who do breath-holding ascents, and I will tell you that nobody knows or will ever know. You cannot do the experiment, because AGE is so often lethal. The whole mechanism of AGE is very, very strange to me, and physiologically, makes very little sense. I mean, we pop lungs on people with ventilators all the time (diseased lungs, of course) but I have never heard of anything like an AGE occurring in the intensive care unit. But there is no question that it occurs in divers, and it is a major cause of death in uncontrolled or panicked ascents.

I don't think anyone would argue that the best thing to do with a diver on the edge of loss of control is to help that person to regain control of himself. If you can't, you are in one of the worst situations anyone can be in while diving -- facing a situation where, if you don't act, the outcome may well be fatal, and if you do act, it may also be. And I don't think anyone who has been bested by terror and wants out of the water should be kept there -- but if slowing the ascent, or doing something to encourage the person to resume breathing can reduce the likelihood of a couple of potentially lethal complications, it seems as though it would be reasonable to try those things.

 

[boulderjohn]

If someone wanted to subsequently sue me for that intervention, then so be it. ...

What you're missing is the context of "... is probably breath-holding".

If a diver is making a fast, but otherwise safe, ascent - then you should slow them (not stop them).

If a diver is making a breath-holding ascent, you need to stop them (and get them breathing, before continuing the ascent).

In the context of a breath-holding panicked ascent, holding you down is considerably safer than allowing you to proceed.

There could be increased risk to the panicked diver by the actions of the rescuer. Just because someone is a "rescuer" doesn't mean they are competant, or skilled, or use sound judgement. So in a hypothetical case where an instructor used unsound judgement in assisting a panicked student and caused them harm, I guess the instructor would be morally,legally,civily in the wrong?

Let's talk about the legal issue.

A professional instructor or DM who is confronted with a situation in which a diver is about to make a panicked ascent has to make a decision. As Andy (DevonDiver) correctly points out, the greatest danger BY FAR is embolism due to holding the breath. Go to any one of the DAN annual fatality reports and see how many of those there are each year--quite a few. Some of you have talked about a diver dying because a professional held him down. I guess it may have happened, but I haven't seen it and would like someone to give a link to it. If it does happen, it is exceedingly rare. That is why, as Andy also points out, training for both the Rescue Diver (nonprofessional) and professional training call for the person to intervene in that panicked ascent.

So, first of all, what is the approach that is more likely to prevent an injury or death? Clearly, the consensus of the scuba industry says overwhelmingly that intervening in the ascent is correct.

So, let's say you are confronted with the situation and have to decide what to do. Here are some things to think about in legal terms.

1. If You intervene in the ascent in an attempt to prevent an embolism, you are acting according to your training and the directives of all scuba agencies. There is nearly no chance that it will create a fatality, and if it did, your defense is that you did the best you could while acting in accordance with what your training said is best practice. I can't imagine you could be held liable for following your training.

2. If you instead decide to let the person continue on that panicked ascent without intervening, there is a very good chance that the person will embolize and die. In that case, don't you think an attorney will want to question why you deliberately failed to follow the standard rescue protocols for which you were trained? I suspect that you would be in real trouble.

 

[Hockeynut]

I once had a guy panic at about 90 feet. I didn't have any time to do anything other than watch him bolt. He ended up ok.

 

[3D diver]

I once had a buddy kick all his air away racing around on a wreck dive at 100+ feet. He initially signaled he wanted to ascend (thumb up) but we still had lots of NDL time and I had plenty of air. He then signaled out of air. He wasn't paniced...yet. My response was to get a firm grip on his BC with my left hand, give him my safe second with my right, then dump his BC. I then moved us over to our third buddy, gave him a kick <G>, and he presented his safe second as well. We began a free ascent and the boat captain, swimming above the wreck as a safety diver, joined us and presented his octopus as well. The four of us reached the surface safely. After reboarding and removing my gear I was about to 'splain the folly of racing around like a bat out of h, e, double tooth picks at 100 feet when we got a call from the boat next to us who had a diver flat on his back with no feeling from the waist down!!!

I'm not sure holding a dive down is appropriate in all circumstances. (I learned in shop class that if something heavy is heading for the ground the best thing to do is get out of the way.) But have learned from this experience, and other incidents in the water and on land, that exercising firm control and physical contact can calm a nervous buddy and keep a bad situation from getting much worse.