Question PADI Rescue Diver Chest compressions

[justinthedeeps]

Yes of course I have done the Rescue Course, and also assisted on a course, and seen other courses going on.

Have also seen professional surf lifesavers, lifeguards, EMS, etc operate and train in far more intense conditions. We are playing with dolls by comparison. I am not saying the course is not good or important though. It certainly is! And continually improving.

 

[wlecyt40]

In training for Rescue Diver, I followed all the steps, followed PADI's instructions, but in real life, my butt is hauling you to the shore/boat then strip your gear off. I am not wasting that precious time dumping gear. Time is short. Get them out of the water, on O2 and definitive care. You have 4-6 minutes before the victim begins to experience brain damage because of lack of oxygen. Once out of the water, you can begin chest compressions, oxygen with demand valve and calling for EMS. This is all assuming we are talking cardiac arrest due to drowning. Sometimes, the victim becomes unresponsive due to low sugar (hypoglycemic). Rescue breathing isn't definitive. Get them out and start caring for the victim.

I shall now step down from my soapbox....

 

[Outbound]

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.

But this begs the question of why the training exercises and evaluations differ from what is being said. I might be completely off-base, but it seems to me that Rescue Scenario 7 (in the PADI course) is just about the least effective thing to do in a real life emergency. So why tell students "Train this way here, but in real life do something else." All of the other scenarios practiced and evaluated during Rescue Diver make sense, but Scenario 7 doesn't. And in a real life emergency, people are either going to completely panic or they are going to fall back on their training. And they trained to take as long as they need to get the person's gear off while towing them so long as they provide rescue breaths every 5 seconds.

 

[tursiops]

Yes of course I have done the Rescue Course, and also assisted on a course, and seen other courses going on.

Have also seen professional surf lifesavers, lifeguards, EMS, etc operate and train in far more intense conditions. We are playing with dolls by comparison. I am not saying the course is not good or important though. It certainly is! And continually improving.

LOL. This is calling damning with faint praise. It also suggests you have no position at all...

In addition, in just this single thread, you have gone from total denigration of PADI to apparent acceptance of its teaching. You appear to slam whatever PADI does based on blind acceptance of what you read that someone has incorrectly posted, to agreement with anything that is said by anyone on anything.

Are you actually a politician, with no real position other than trying to make people think you are on their side by always agreeing with them?

Are you able to distinguish between PADI teaching exercises and drills so you can attain some moderate skills, and actual rescue situations where you have to use your judgement while trying not to violate some of the basic critical items....like a breath every 5 seconds? You say you took Rescue; was with the kind of instructor you seem to think dominates (poor, underpaid, uncaring, incompetent) or with the kind you admire? If the former, do you think it is fair to suggest all instructors and Rescue classes are like that?

 

[wlecyt40]

But this begs the question of why the training exercises and evaluations differ from what is being said. I might be completely off-base, but it seems to me that Rescue Scenario 7 (in the PADI course) is just about the least effective thing to do in a real life emergency. So why tell students "Train this way here, but in real life do something else." All of the other scenarios practiced and evaluated during Rescue Diver make sense, but Scenario 7 doesn't. And in a real life emergency, people are either going to completely panic or they are going to fall back on their training. And they trained to take as long as they need to get the person's gear off while towing them so long as they provide rescue breaths every 5 seconds.

When I was taking my divemaster training and during my AOW training, I asked why are we doing it this way? "Because this is the way PADI has us train it." I disagree with it. After 18 years in EMS and dealing with drownings, cardiac arrests, and traumatic arrests, I have found that there is always a better way. I know that PADI wants to acutely stress load you in training so you know what to expect if it really happens, but I also know that all plans sound great until first contact with the opposition (Army sense of humor). I even question why we don't use the victim's reg if they still have it in their mouth and they still have air in the cylinder. It actually has about the same force as you blowing into the mouth and it is sealed against the skin. You can use the E clamp technique EMT and paramedics use when breathing for someone with a bag valve mask.

I don't design the memorandums of instruction for PADI nor do I totally disagree with much of their training, but I do believe there are better ways to evacuate, extract, evaluate and treat your patient.

 

[tursiops]

But this begs the question of why the training exercises and evaluations differ from what is being said. I might be completely off-base, but it seems to me that Rescue Scenario 7 (in the PADI course) is just about the least effective thing to do in a real life emergency. So why tell students "Train this way here, but in real life do something else." All of the other scenarios practiced and evaluated during Rescue Diver make sense, but Scenario 7 doesn't. And in a real life emergency, people are either going to completely panic or they are going to fall back on their training. And they trained to take as long as they need to get the person's gear off while towing them so long as they provide rescue breaths every 5 seconds.

The point of Exercise 7 (not Scenario) is to teach you how to do something that you might need to do...not to tell you you must do this during a rescue. "Slow is smooth, smooth is fast." Learn how to do it so if you need it you can do it. It is like in the Open Water class you learn how to take off youf BCD underwater and put it back on. You don't do that on every dive! I hope you never have to. But if you get entangled, or your tanks slips off the cam bands, you can fix that if you need to, with a bit of confidence.

 

[ChrisMBC]

I even question why we don't use the victim's reg if they still have it in their mouth and they still have air in the cylinder. It actually has about the same force as you blowing into the mouth and it is sealed against the skin. You can use the E clamp technique EMT and paramedics use when breathing for someone with a bag valve mask.

Curious if you know of any testing/source for this? I always assumed that purging a reg into an unconcious victim's mouth wouldn't do much good, as the air would just come out of the exhaust valve. Rescue breaths and bag valve create some amount of positive pressure that (I think) would be impossible to generate with a second stage.

 

[tursiops]

why we don't use the victim's reg if they still have it in their mouth and they still have air in the cylinder. It actually has about the same force as you blowing into the mouth and it is sealed against the skin. You can use the E clamp technique EMT and paramedics use when breathing for someone with a bag valve mask.

Several reasons not to do that in addition to the previous post: There is no over-pressure relief valve so you can blow the lungs out; it takes more training; there is not always air in the tank...or even a tank. The old DAN rescue kit used to have a forced ventilation inhaler; it was replaced by one with an overpressure valve, for good reason.

 

[Duke Dive Medicine]

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?

I agree. You're very limited on what you can do with an unresponsive diver in the water. It's difficult to even assess breathing with the diver in full gear and immersed up to the neck. I have not taken the PADI rescue diver course so I can't speak to it at all, but I imagine it as adding to the toolbox of a diver rather than laying down a set of absolutes, that is, "If the diver is 'X' then always do 'Y' and expect 'Z' result." It's training recreational divers who probably don't have a medical or professional diving background in the basics of rescue and resuscitation, and has to be applied in the context of the scenario and with a certain amount of critical thinking. If I'm with an unresponsive diver and the boat is 500 yards away, it would be reasonable to try to signal for help and then attempt to assess breathing and provide ventilations as best I can, with the understanding that that may not be enough. If I'm at the surface on the anchor line, then I'm going to engage help and get the diver on the boat as quickly as possible in order to better assess him/her and provide care that wouldn't be possible in the water.

Best regards,
DDM

 

[lowwall]

I took the PADI rescue course 1.5 years ago. As has already been established, there was no attempt to teach in-water chest compressions. It was also explicitly stated that while gear was removed for the exercises, this did not mean it should necessarily be removed during a real emergency. Removal depended on the circumstances with priority for unconscious/unresponsive divers given to getting them out of the water as quickly as possible.

I did the rescue breath every 5 seconds as the last scenario (scenarios?) required. But my take away from the discussions we had during the course was to give two rescue breaths once we got to the surface in the hopes that would restart breathing, but then concentrate on getting the victim to someplace solid as fast as possible.

edit: DDM posted while I was writing my post. We did discuss the very long swim or long wait on the surface for someone to get to us as the appropriate times for attempting continued rescue breaths, although it was acknowledged that there was a very small chance that it would improve the outcome.