Near drowning incident - November 12, 2016

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kensuf

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Scuba Instructor
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Gainesville, FL
Near-drowning is a term used to describe almost dying from suffocation under water. It is the final stage right before actual drowning occurs. On November 12th, I was involved with the rescue of a near-drowning victim in a spring that I’ll leave unnamed. The victim survived, but I am posting this report of my observations of the event here in the A&I forum because I think there are some very valuable lessons to be learned, especially for newer divers.

Description of Site
The site is a shallow basin, approximately 150’ wide, fed by a first magnitude spring. Water temps are 72° and with visibility usually in excess of 200’, it makes for a very popular training location. There is a deck with multiple sets of stairs leading to the water, and frequently divers and swimmers will be congregated around the stairs. Most of the basin has a depth averaging 3 to 5’ deep, but in the center of the basin there is a bowl-shaped depression with a drop to a depth of 15’. The side of the “bowl” that is closest to the stairs is a flat wall with a sheer drop to maximum depth, and the side furthest away from the stairs has a gradual sloping floor. The sheer wall is no more than a dozen feet from the closest set of stairs. There is a cavern beneath the basin that extends underneath the surface and beneath the deck, the entrance to the cavern is on the sheer wall closest to the stairs.

Details of the Incident
I was teaching a cave class that day and on the far side of the basin from the stairs with a student. We were conducting a pre-dive briefing when out of the corner of my eye I noticed a diver bobbing up and down by the sheer drop-off, approximately 100’ away from me. I observed his head drop beneath the surface, then come up and gasp air. I then watched his head descend under the surface a second time, at which point I put my mask underneath the water. I saw that the diver was holding his fins and mask in his hand, with his regulator out of his mouth and saw him kick for the surface. I told my student that I would be back in a moment, and swam over to the diver as he was beginning to descend a third time. I reached him as he lost consciousness, brought him to the surface, and notified several people on the surface that I had an unconscious diver.

I proceeded to tow the diver to the nearest set of stairs. Luckily, a rescue class had just wrapped up at the site for the day and the students took over the extraction of the diver. The diver began to revive as they were carrying him up the stairs. Once he was brought to the deck he was given oxygen, and local EMS were activated. The diver was treated by paramedics and released without transport to a hospital.

Personal Observations
The diver was wearing a jacket style BC with an integrated weight system and he was overweighted with ballast. During the rescue I noticed large quantities of air leaking from the pull dump on his corrugated inflator hose, so it appears that he had taken his mask and fins off, while floating on the surface right next to the drop off, when the pull dump failed. My best educated guess is that once he lost the ability to maintain positive buoyancy, he began to sink uncontrollably.

I find this incident interesting for a couple of reasons. The first reason is that there were two scuba divers standing in the shallow area no more than 5’ away from the victim that were unaware of the problem unfolding next to them. Either one of those divers could have easily assisted the victim before he lost consciousness. If the diver had simply shouted for help after the first or second time he went underwater they would have likely been able to assist him.

The second reason is the diver had a fully functional regulator and air in his tank, but because his hands were occupied holding his fins and mask, he was unable to put a regulator in his mouth. If he had simply dropped his fins and mask, he would have been able to put a regulator in his mouth and dealt with his situation.

Lessons to be Learned
I think the following lessons can be learned from this incident:

First and foremost – you should never wear so much ballast that you cannot maintain buoyancy if your BCD fails.

Second, if you are having an emergency don’t hesitate to shout for help.

Finally, and most importantly, if you are in a situation like this, your priority should be to get a breathable air supply so you can then have the time to properly deal with the situation. In this case, the situation would have been resolved by ditching his ballast when he had time to realize his BC had failed. Losing a pair of fins or a mask is a small price to pay compared to potentially drowning; several years ago an active member of the TekDiver Mailing List drowned because he was so focused on keeping his mask he made an error in judgment (RIP Robert Wolov, you are remembered).
 
Rather obvious points in hindsight. That doesn't mean they're as obvious for the victim, in the middle of the situation. Which is why I repeatedly tell myself that gear is replaceable, life isn't. I really hope that if I'm ever in a situation like that, I'll be able to remember just that. It's just money.

And kudos for noticing what whas happening and saving a person's life. I'm going to buy you a virtual beer for that!
 
Everything in this report is consistent with some of the reading I have been doing on drowning, and I am talking about articles unrelated to scuba. It is also completely consistent with a near drowning on scuba some friends of mine observed in Florida some years ago.

Real world drowning does not look like what we practice in a Rescue Diver class. Divers are rarely panicking, splashing, and screaming. They are doing exactly what Ken describes, and they can drown right next to someone who could easily help but never noticed anything gong on. For some reason they don't respond when people make suggestions to help.

In the case my friends observed, they were on a boat moored to the Spiegel Grove after completing a dive when their DM started shouting at another boat, telling them one of their divers was in trouble. They saw that a man was struggling to get to that boat, his head going under water and coming back up as Ken describes in the incident above. The other boat's crew did not seem to understand, so the DM started screaming at the man to inflate his BCD. He didn't. He just slipped under water and didn't come back up. The DM dived in and recovered him. He was unconscious but responded to the CPR by vomiting and coming out of it.
 
I am the student that kensuf was teaching on that day. To further add to the observations it was a very busy day. There was a reasonable number of divers, snorkelers, and swimmers already in the water in addition to the number of people that were on the shore looking at everyone in the water. Secondly, one of the two divers that was just a couple of feet from the victim was a certified instructor.

Nobody recognized what was going on even though the victim was only a few feet away from them. Luckily kensuf was able to get to him just in the nick of time.
 
Kudos to @kensuf for his timely action. Kudos to @Storker for his link to Silent Drowning.

First and foremost – you should never wear so much ballast that you cannot maintain buoyancy if your BCD fails.
Indeed. You should be neutral or barely negative without any air in your BC. That means your head should just be awash.. with no air. Exhale to descend.

Second, if you are having an emergency don’t hesitate to shout for help.
You can't shout if you're trying to breathe in, Ken. The perceptual narrowing won't allow it. This near drowner was in near panic. Their brain had shut down higher functions like speech in favor of the atavistic need to simply breathe. This is why most drownings are incredibly quiet.

Finally, and most importantly, if you are in a situation like this, your priority should be to get a breathable air supply so you can then have the time to properly deal with the situation.
Even better would be to not relinquish your breathable air supply until you're on dry land. This is why you'll hear captains yelling at you to put your reg back... just in case! No captain to do that at a spring.

Never dive solo unless you are trained for it and have the right mentality for it. Not even for a moment. Your duty to your buddy is from splash until after a successful exit. You're not only their redundant air: you're their redundant MIND. While their perceptions narrow to just trying to get the next breath, your full faculties, like Ken's, are able to identify and resolve your buddy's problem. But only if you're paying attention.

Great thread, Ken and again: kudos for being their and attentive.
 
Ken,

Nice catch. You'll carry this with you, as will the individual you saved and probably the people you spoke of who were next to him but didn't notice he was in distress.

Thank you for the well-written post. I would add that in a panic, rational thought about weights and regulators goes away, and that's when (hopefully) someone like you steps in. A large part of dive training consists of raising the panic threshold, but the impact of that can vary widely. Hats off to you.

Best regards,
DDM
 
If the diver had simply shouted for help after the first or second time he went underwater they would have likely been able to assist him.
Great rescue, but I'm told that you can't shout once you reach that level of distress.


Characteristics of the Instinctive Drowning Response:
(http://www.uscg.mil/hq/cg5/cg534/On Scene/OSFall06.pdf page 16)

1. Except in rare circumstances, drowning people are physiologically
unable to call out for help
. The respiratory system was designed for
breathing. Speech is the secondary, or overlaid, function.
Breathing must be fulfilled, before speech occurs.

2. Drowning people’s mouths alternately sink below and reappear
above the surface of the water. The mouths of drowning people
are not above the surface of the water long enough for them to
exhale, inhale, and call out for help. When the drowning people’s
mouths are above the surface, they exhale and inhale quickly as
their mouths start to sink below the surface of the water.

3. Drowning people can not wave for help. Nature instinctively
forces them to extend their arms laterally and press down on
the water’s surface. Pressing down on the surface of the water,
permits drowning people to leverage their bodies so they can
lift their mouths out of the water to breathe.

4. Throughout the Instinctive Drowning Response, drowning
people cannot voluntarily control their arm movements. Physi-
ologically, drowning people who are struggling on the surface
of the water cannot stop drowning and perform voluntary
movements such as waving for help, moving toward a rescuer,
or reaching out for a piece of rescue equipment.

5. From beginning to end of the Instinctive Drowning Response
people’s bodies remain upright in the water, with no evidence of
a supporting kick. Unless rescued by a trained lifeguard, these
drowning people can only struggle on the surface of the water
from 20 to 60 seconds before submersion occurs.
 
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When I have taught the rescue class, I have taught the information contained in Kevin's post above. It is not in the course materials. Instead, we have students practice intensely for scenarios that really never happen.
 
A large part of dive training consists of raising the panic threshold
To me, this is more of a function of experience. We can show people what to do and when, but they'll still be like a deer in the headlight when presented with similar yet somewhat different scenarios. I think it's a noble aspiration, but I don't have a clue how to raise their panic threshold, especially since we aren't allowed to do harassment drills anymore. I feel that they were not only great for the new diver, but they were fun as hell for everyone.
 

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