Question PADI Rescue Diver Chest compressions

[Learner Diver]

If it doesn't work in a pool, it sure won't work in the ocean.

Good points if you can replicate an ocean dive in a pool.

 

[Dr Simon Mitchell]

Hello,

A lot of the questions / points of controversy debated in this thread are explicitly addressed in the paper posted by lowwall. I would suggest that anyone genuinely interested in the topic read it carefully. I have posted it again here.

The most important point that often seems to be overlooked is that in contrast to community cardiac arrest where a myocardial event and the resulting cardiac arrest itself is the cause of cessation of breathing, in a hypoxia or drowning situation (likely in diving), cessation of breathing may occur before cardiac arrest, but cardiac arrest will follow relatively quickly if oxygenation of the blood is not resumed. Thus, there is a window within which providing breaths may prevent progression to cardiac arrest. This is important because if cardiac arrest occurs in a field / aboard boat scenario then the prognosis is extremely poor no matter what you do.

The recommendations of the UHMS Diving Committee (largely adopted by PADI) were crafted around trying to exploit this window on the basis of some supportive evidence that is cited in the paper. It is well recorded that divers in respiratory arrest have resumed breathing and regained consciousness after rescue breaths, essentially proving they were not in cardiac arrest. There is some supportive evidence for rescue breaths in the drowning literature. I agree that chest compressions in the water are a waste of time and to my knowledge PADI have never recommended them. Moreover, the wording in the paper is nuanced to reflect the fact that rescue breathing can be challenging and should only be done if the rescuer is physically up to it.

In relation to the use of a scuba regulator purge button for positive pressure ventilation, I cautiously agree with those who have advised that it is a bad idea for the reasons specified (mainly the potential to produce lung over-pressurization). I say cautiously because it was successfully done multiple times during the Thailand cave rescue on occasions when the boys stopped breathing and no obvious lung injuries resulted. We discuss this in our paper on the rescue, and we tested the pressures generated by using the purge button. They can indeed become dangerously high. I have attached that paper too.

Simon M

 

[Nosmosis]

I am an instructor for CPR for American Red Cross, American Heart Association, Health & Safety Institute and FRTI. We always teach people the importance of identifying cardiac arrest and beginning compressions with rescue breathing as soon as possible (as well as early use of AED). In drowning, we do breaths first. On land we encourage people to move a victim from a couch or bed to a hard surface such as the floor to provide compressions. We also emphasize correct hand placement and technique for quality CPR.

I have no idea what compressions in water would look like or do to help the victim other than delay getting them to shore.

 

[pauldw]

Good points if you can replicate an ocean dive in a pool.

If it doesn't work in the pool, it won't work in the ocean. Being able to do it in the ocean only becomes a question if you can do it in the pool.