Question PADI Rescue Diver Chest compressions

[JohnN]

Yes, which is why I was asking what page it was on.

View attachment 845823 Exactly!

And please tell me how you plan to depress the sternum 1.5 - 2 " while in the water?

 

[Outbound]

I think you have missed my point. Chest compressions in water are not effective. Period. End of Statement. Full stop. There is no decision to make about doing them as part of a rescue

FWIW, even out of water, the success rate is <20% under the best of circumstances and you risk doing more harm than good.

https://www.npr.org/sections/health-shots/2023/05/29/1177914622/a-natural-death-may-be-preferable-for-many-than-enduring-cpr

Just to clarify. I don't think anyone is saying that in-water chest compressions are effective and that the decision is whether or not to do them. You can't do in-water chest compressions. The decision is whether to give rescue breaths while towing the victim to shore/boat/dock or hauling ass to shore/boat/dock to get them on a hard surface to do CPR.

 

[justinthedeeps]

Pay does not come from PADI. If you are working with a shop, it comes from the shop. If you are independent, it come directly from the students. PADI does no training and pays no instructors (at least, as instructors; they have employees who also happen to be instrictors but instrcting is not the source of thier pay).

Indeed. Forgive me for being facetious...

It is true that the level of safety, honesty, rigor, discipline that shops, students and instructors adhere to is largely up to themselves. This is serious issue, under the pressure of a market dominated by students who are happy to purchase certifications at a minimum cost and time. Most PADI-affiliated shops have not been the worst in this regard.

Thank you PADI for trying somewhat to instill quality control. The written PADI standard are actually quite good for a lot of the courses. Unfortunately, there is a disincentive for instructors to withhold certifications from divers who haven't really demonstrated appropriately high levels of performance. Again not only a PADI problem.

As for the 'super strict' you must give exactly two breaths every five seconds thing? Did they consult with real EMT/EMS/MDs on that? And now some language sounding like in-water compressions of some sort? What?

 

[Duke Dive Medicine]

Seems like the article isn't available online anywhere, but I'd like to read the paragraphs following this. That text doesn't actually say that you provide in-water chest compressions - it says that you have a "decision to make", and that the victim will need rescue breaths and chest compressions. The next sentence could easily be "If you are close to surface support/shore, prioritize getting the diver out of the water so that you can provide chest compressions".+

^Agree with this.

I think you have missed my point. Chest compressions in water are not effective. Period. End of Statement. Full stop. There is no decision to make about doing them as part of a rescue

FWIW, even out of water, the success rate is <20% under the best of circumstances and you risk doing more harm than good.

https://www.npr.org/sections/health-shots/2023/05/29/1177914622/a-natural-death-may-be-preferable-for-many-than-enduring-cpr

Your point is well taken. I think the question is whether the article actually recommends in-water compressions. Going just by the excerpt below, you could interpret it that way. Is there additional context? What comes after that?

This came from "SCUBA Diving", June 2024. (FWIW the magazine is a PADI publication)

The excerpt:
"The PADI Rescue Diver course teaches that when you discover an unconscious diver in the water, you should protect his or her airway. Get the diver's face out of the water and shield it from waves or splash. Get the diver positively buoyant. Then you have a decision to make. The diver will need for you to breathe for them and deliver chest compressions as well to maintain circulation"

 

[tursiops]

Did they consult with real EMT/EMS/MDs on that?

Yes. ILCOR guidelines are followed.

And now it's in-water compressions of some sort?

No, don't believe everything you read on ScubaBoard.

 

[justinthedeeps]

It seems like tilting the head back to open the airway is an added risk in the water, due to the increased chance of taking on more water, or fouling an airway that is not yet compromised. Though it may "wake up" a diver who isn't actually fully unconscious or arrested. Yes I am taking into account the dropping of weights, inflation of BC, getting under the diver etc. The problem still exists. Especially in rough conditions.

Instead of admitting that the added task loading and complication of giving rescue breaths is actually likely to delay transit of the vicim to solid ground (or a boat), just put it all on the trainee that it must be done at full swimming speed.......ok

Might work as a choreographed demonstration in a pool or a calm bay, with a short swim.

 

[Outbound]

I fully and honestly welcome feedback from medical professionals and those who have more knowledge than I do...

I always thought the way I was trained in Rescue Diver for the "full monty" scenario had a LOT of problems. As @justinthedeeps mentioned above, it's really only possible to pull off in flat conditions, and even then it begs the question of whether or not the trained response is actually going to do any good. First, why remove a victim's mask and regulator in open water? Yeah, you do it to check if they are breathing, but now you have just exposed the person's airway to water. Second, it is extremely difficult (if not outright impossible in real conditions) to get high enough while in the water to deliver effective rescue breaths to an unresponsive victim without compromising their airway in some fashion. It's easier with a pocket mask, but who really carries one of them on each dive? Third, it takes a lot of time to yank weights, undo BCD clips, and get both people out of gear. In the training, the duration of all that doesn't matter so long as the student provides a rescue breath every 5 seconds. That's kinda bogus, no? In real life the clock is ticking from the moment the person went from conscious diver to unresponsive victim. Fourth, students end up towing "victims" in circles because they concentrate so much on all of the required steps that they forget to look where they are towing the person.

As an exercise in acute task loading it works. As training for how best to respond to an actual in-water emergency, I think it leaves a ton to be desired.

Unless and until I am provided with information and evidence to prove otherwise, if I'm ever faced with a scenario where I'm dealign with an unresponsive diver in the water, I've leaving their mask on and their regulator in their mouth, I'm going to yell and signal for help, and I'm towing that person as fast as I can to the nearest hard surface. The only time I would give in-water rescue breaths and remove gear would be if I've signaled the boat and they are coming towards me and I want to get the victim ready to be hauled out of the water.

Thoughts?

 

[wlecyt40]

As a paramedic and having worked drownings, you never perform compressions in the water. You need a solid surface to be able to provide proper compressions. On many occasions as an instructor, I have told my students to take them out of the bed (which is soft) and get them on the floor to provide compressions. They need to be on their back and flat. Water doesn't provide the type of resistance that good old Mother Earth can provide.

 

[justinthedeeps]

Here is another question I have about the PADI surface drill, as currently prescribed by PADI (and its consultants):

If we just get someone to shore or boat as quickly as possible, and end up skipping or missing PADI rescue breaths, are we now considered liable for negligence for not doing that? Or is even PADI/DAN/insurer etc themselves going to say, well, we reason that you probably missed some rescue breaths, so we will have to carefully consider your professional liability insurance here?

Lawyers are gonna lawyer......

 

[tursiops]

It seems like tilting the head back to open the airway is an added risk in the water, due to the increased chance of taking on more water, or fouling an airway that is not yet compromised. Though it may "wake up" a diver who isn't actually fully unconscious or arrested. Yes I am taking into account the dropping of weights, inflation of BC, getting under the diver etc. The problem still exists. Especially in rough conditions.

Instead of admitting that the added task loading and complication of giving rescue breaths is actually likely to delay transit of the vicim to solid ground (or a boat), just put it all on the trainee that it must be done at full swimming speed.......ok

Might work as a choreographed demonstration in a pool or a calm bay, with a short swim.

Apparently you have not taken PADI Rescue, or at least not recently enough to remember it?
You do NOT automatically remove equipment and give rescue breaths in all situations. Yes, you demonstrate doing it during the exercises and evaluations, but the training is quite explicit: get the diver out of the water is the priority....while keeping at least one breath in their lungs every five seconds if possible. And those rescue breaths can be using a snorkel or a pocket mask...to help keep water out of the airway.

I hope you ae aware that PADI does not just make this stuff up; they try and follow the ILCOR guidelines as far as possible in a diving accident.