In water rescue breaths

[divingdingo]

As a PADI instructor i have myself been trained and have trained all my divers taking a rescue course and up the technique of giving rescue breaths to an unconcious diver at the surface. this includes making sure that whilst seeking land or boat the rescuer is administering rescue breaths every five seconds and also removing equipment. i'm sure many PADI divers are familiar with this training.

however whilst recently on a liveaboard i had the pleasure of befriending a very humble and modest whilst extremely experienced CMAS instructor. during the trip we discussed the various merits and disadvantages of both systems of teaching. however it seemed that a major diference in the two training techniques between this instructor and PADI was that he disagreed entirely with rescue breaths on the surface. stating the following reason

"it would be wasting your time on the surface trying to administer ineffective rescue breaths to a victim who you can not be sure has a pulse (if no pulse victim needs CPR immediately) and if the victim has a pulse the victim would in all probabilityl be breathing aswell and thus needs oxygen immediately. he needs to be brought back to oxygen ASAP"

i felt this made sense however it's hard to go against my training. the CMAS instructor went on to say that most other diving bodies would advocate PADIs rescue breath training in favor of oxygen admin ASAP.

as this is my first thread and a newcomer to scubaboard i'm unsure whether this is a common discussion issue or not, although i'm interested to hear of anyone's opinions on the above, either from PADI instructors, CMAS instructors or anyone with a thru'pence to throw in

divingdingo

 

[Jim Ernst]

most of the medical asso, are talking of doing away with the rescue breath method, though at this time it dose still stand, as an emt i was trained that the rescue breath still puts some (minimal) 0/2 to the avaoli in the lungs, thus a small amount of help, as i was saying they are discussing doing away with the rescue breathes due to the fact that it does take longer to get the victum to the possibilty of 0/2 plus cpr and being able to restore circulation, and as i am sure you know with out the circulation the small amount of 0/2 from rescue breathes is really futile, so we will see the outcome soon i am sure, i personally, though padi traind dm, would think that some good rescue breathes fine but get victum to major med help soon is more important!!

 

[TSandM]

If you think about it, what you are trying to do is provide oxygen to tissues. That requires oxygen getting into the lungs, and circulation to carry it to the body.

Now think about why somebody isn't breathing, especially somebody who has been underwater. Did they get something that has rendered them unconscious and without a strong reflex to breathe? That can happen with high CO2 levels -- but the catch is that by the time you no longer want to breathe because of high CO2, you probably don't have a pulse any more, either. Similarly, with carbon monoxide -- you can lose consciousness, but you're still breathing; if you stop breathing, you probably stopped perfusing tissues at the same time. There are very few things that make you stop trying to breathe but preserve a good pulse and blood pressure, and I don't think there are very many narcotic overdoses underwater

So, if someone has quit trying to breathe, their circulation is probably pretty suspect as well. Circulation cannot be provided effectively in the water, and it can't be very easily evaluated, either. In the case of a diver who has quit trying to breathe, you are very probably better off getting that person OUT of the water, where circulation can be better evaluated and assisted, than trying to provide a couple of rescue breaths, of marginal effectiveness and probably in the face of severely compromised circulation.

This would be my assessment as an ER doc. Don't delay what could be really useful to provide an intervention of dubious efficacy.

 

[divingdingo]

Re: previous training methon in PADI course.

does anyone know if PADI is the only training agency which teaches this method of rescue to an unconcious diver at the surface?

 

[Jim Lapenta]

Good thread! I'll be interested to hear the results of this question as Iwas just informed that in the next 2 weeks or so I'll have to demo my rescue skills for my DM class.

 

[Dive-aholic]

PADI just added use of a mask during rescue breathing in the rescue course. I don't believe they will be eliminating rescue breathing anytime soon. I'm not familiar with what other agencies are doing. However, I'm with TSandM - don't delay needed treatment to attempt ineffective treatment. Rescue breaths don't do anything if the blood isn't being circulated. Circulating blood (through compressions) can be effective for a short period of time without rescue breaths. The American Heart Association has been studying CPR without rescue breaths and may be changing layman standards in the near future. Most lay people aren't willing to rescue breathe strangers and won't perform CPR at all. If compression only CPR is taught, it may slightly improve survival rates. Hopefully PADI will see this and change their standards as well.

 

[BigJetDriver]

So, if someone has quit trying to breathe, their circulation is probably pretty suspect as well. Circulation cannot be provided effectively in the water, and it can't be very easily evaluated, either. In the case of a diver who has quit trying to breathe, you are very probably better off getting that person OUT of the water, where circulation can be better evaluated and assisted, than trying to provide a couple of rescue breaths, of marginal effectiveness and probably in the face of severely compromised circulation.

This would be my assessment as an ER doc. Don't delay what could be really useful to provide an intervention of dubious efficacy.

As DMT, I'm with the Doc here in her assessment. It should also be noted that American Heart and other CPR agencies have recently changed their guidelines to put more emphasis on thoracic pressure as the primary goal, although oxygenation is still needed.

The faster you get the patient on the deck of the boat, the better will be your chances of providing effective help.

Just my ppO2's worth.

 

[divingdingo]

thanks for all the responses on this one. all the reasoning flies in the face of what i have to teach when i conform to the PADI standards. the only thing i can suggest to PADI divers is to practice, practice and practice again the sequence of 'unconcious diver at the surface' as the more fluent we are with it the less time we will waste before O2 can be administered.

divingdingo.
safety is paramount, none of us are born with gills!

 

[pipedope]

I wonder if a good compromise might be one or two rescue breaths as soon as you get to the surface then get the victim ashore or on deck as fast as possible where more effective treatment can start?

My thinking is that there is some chance (small) that you might get the extra O2 in the lungs just in time to restart the breathing and it doesn't take long to do one or two.
I think that continuing breaths while towing would just slow you down and waste time.

I am not a medical professional but I have seen one case where an unconscious diver started breathing after one rescue breath.

 

[TSandM]

Of course, part of the problem is that it is hard to do any kind of reasonable study to determine what the best course of action in the event of an unconscious, non-breathing diver at the surface is. Luckily, such cases are rare enough that reports are essentially anecdotal. Some people might respond to a breath; some people might be much better served by early CPR and 100% O2. In the absence of any kind of gathered and analyzed data, you have to use the best common sense you can. I don't think, whether you give rescue breaths or not, anyone can really say you did something wrong.