Insights from Rescue for BP/W users

[GreenDiverDown]

Not being critical here at all, but does "basicly hosed" mean give up, I seem to recall you are an ER Dr. so I mean this as a serious question? i.e. where is the trade off between a longish swim towing and trying to do some kind of in water CPR/rescue breathing? Do you stop every little bit and try again or give up the attempt at breathing and just swim as fast as possible to shore/boat. Not clear where the line might be, I think it might be helpful for you to share your thoughts.

Not to put you on the spot. and I will understand if you don't want to respond in detail - liability issues and such.

I suppose this would depend on one's swimming ability and their resuscitation skill set.
Far too often I have seen ineffective ventilations being carried out in the best of circumstances... under the bright lights in an ER suite. Toss that victim and rescuer in the water and do you think that the chances of that effort will improve? Not likely.

I think a skilled swimmer and an experienced resuscitator has a good shot at providing effective ventilations while towing a victim at a pretty good pace. But at some point you gotta just get the victim to a better environment... the quicker the better. So much of the decision making would involve looking at the big picture and how much of that picture can be seen depends on one's training and experience. I'm sure that the way Lynne, Catherine, DivinCRNA, or I would evaluate a situation would be much different than an 18 year old DM.

I would hate to see the removal of a victim from the water delayed by a rescuer delivering nothing but ineffective ventilations.

 

[GreenDiverDown]

Catherine,

The "zip it" was only meant to ask pros like you to not answer the pressure and volume questions that I posed... at least not until everyone else had a chance to think about them. It's no fun if you give up the answers too quickly!

I think that you are a great source for helping the laymen understand some of the realities of resuscitation... you've been in the trenches and you know the score.

So have at it!

 

[Cacia]

Catherine,

The "zip it" was only meant to ask pros like you to not answer the pressure and volume questions that I posed... at least not until everyone else had a chance to think about them. It's no fun if you give up the answers too quickly!

I think that you are a great source for helping the laymen understand some of the realities of resuscitation... you've been in the trenches and you know the score.

So have at it!

OH! I thought you meant don't post at all. I am a little slow.

 

[Cacia]

Okay, in the meantime, I have thought about my source of anxiety on this issue. It is this: Even though I have been involved in a couple hundred "codes" I do not have confidence that I can perform effective rescue breathing while towing. It would not bother me except that everyone on the boat is going to be looking and watching and documenting! And I will probably be the most qualified person and I do not think I can pull that part off. It is the airway, tongue, part that I am pretty sure would not be effective if I was doing it. We have big seas here in Hawaii!

Could you all just ignore certain people?

 

[Jasonmh]

woowooo... post #150!

The ongoing portion of this thread that really astounds me:

"Cutting thru the straps with a dive knife"

Laughed so hard I almost puked. I have never seen a sharp dive knife more than a week old that wasn't owned by a Government and operated by a muscle bound kid dressed in Olive Drab...

Other than that- never seen one that was sharp enough that it could open an envelope.

Can't happen. Commercialy available shears included. (Non Pro-EMT)

What are you talking about? I have a pair of <15 dollar shears that can cut through webbing straps just fine. Also a 2 year old dive knife that has never been sharpened that can too, although maybe not as well as the shears. In fact I used my shears like 2 weeks ago to cut the excess webbing off a new backplate. Have you every actually tried it yourself?

The removal of the backplate and wing issue is not too difficult. Yes, it is alittle different, but not that bad. For anything short of unconscious diver, it is like talking of a coat. Just pull the straps off the shoulders. For unconscious diver, you can pull the straps off the shoulders to get the extra slack (not always needed but makes it easier), bend the arm at the elbow and place the divers hand on his/her chest under the shoulder strap, pull strap over arm/shoulder. I had to do this during my rescue class when one person's buckle got jammed on their regular BC and would not come undone. So, it is: Crotch strap buckle, drop weight belt, one shoulder, other shoulder. As someone else mentioned here, it did not take long at all, and certainly was not appreciably longer then undoing the 4 or more plastic buckles on a regular BC. And it will work on anyone, well anyone who's elbows work. If you can't touch your own shoulder with your hand then you probably aren't able to get in a BC to begin with. That said though, if I were the one in trouble I would have no problem with someone cutting my webbing, cost all of 10 bucks to replace.
It is a shame to hear that some agencies decided to take the view that if someone is using different gear that they just can't be helped, instead of taking a minute or 2 and thinking about how it could be done.

 

[dherbman]

Could you elaborate on the "airway, tongue" issue? Apologies if it's been covered, I may have lost it in the static.

When I did S&R, it seemed as though placing my right arm under the neck and right hand on forhead, I could get enough extension that the airway would be clear and my left hand was free.

Could someone also elaborate on what constitutes "effective" rescue breathing?

 

[Cacia]

Could you elaborate on the "airway, tongue" issue? Apologies if it's been covered, I may have lost it in the static.

When I did S&R, it seemed as though placing my right arm under the neck and right hand on for head, I could get enough extension that the airway would be clear and my left hand was free.

Could someone also elaborate on what constitutes "effective" rescue breathing?

well, you can have the correct position in a drill and because you are not actually inflating the victim's lungs, it is not very apparent if the tongue has slid back in the throat, obstructing the airflow. The movement of swimming, the waves, trying to remove the BC, it all just makes me wonder if I could actually be effective. I am a big supporter of those first two breaths because free divers, who black out pretty frequently, have their airway positioned and they are stimulated they often resume breathing.

 

[GreenDiverDown]

Okay, in the meantime, I have thought about my source of anxiety on this issue. It is this: Even though I have been involved in a couple hundred "codes" I do not have confidence that I can perform effective rescue breathing while towing. It would not bother me except that everyone on the boat is going to be looking and watching and documenting! And I will probably be the most qualified person and I do not think I can pull that part off. It is the airway, tongue, part that I am pretty sure would not be effective if I was doing it. We have big seas here in Hawaii!

Catherine,

All that anyone can expect of you is for you to do your best. If the conditions are tough or if you feel that you aren't getting effective ventilations, then high-tail it to the boat. Get the victim out of that environment and continue the resuscitation.

OTOH, in calm water, you might be surprised at how good the positioning is for ventilating the victim.

Confidence in our abilities is one thing... confidence that we can beat the ocean might be naive. Trust your judgment. Trust your experience and training. Have confidence that you will do your best. That's all the confidence that you need. A victim would be lucky to have you on their side.

 

[Cacia]

Thank-you and Tsand for taking the time to post informative replies. I actually got a lot out of this. (the cold-water factor, the pressure issues, the "stay flexible", etc)

 

[GreenDiverDown]

well, you can have the correct position in a drill and because you are not actually inflating the victim's lungs, it is not very apparent if the tongue has slid back in the throat, obstructing the airflow. The movement of swimming, the waves, trying to remove the BC, it all just makes me wonder if I could actually be effective.

Exactly!

But YOU, at least, will know. YOU have the experience that enables you to know when your ventilations are going in. YOU can easily tell if the airway is occluded and YOU will try to re-position. You're way ahead of the pack with this in mind. Another advantage that you have is that you've been there, done that AND got the T-shirt... so to speak. When the feces hit the fan you aren't as likely as most to fall victim to panic and indecision. Everybody's BP goes up when under the gun but people with your background have long ago learned to control the anxiety... to focus clearly on what is happening.

If not outmatched by the sea, you will be able to provide effective breaths. Use your judgment to decide when you need to high-tail it back to the boat.