Question PADI Rescue Diver Chest compressions

[Duke Dive Medicine]

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.

You'd be putting the diver at an unacceptably high risk of pulmonary barotrauma. We don't use positive pressure ventilation O2 regulators any more for the same reason. Most bag valve masks have pop-off valves and it's much easier to gauge effectiveness with the patient dry and in front of you.

Best regards,
DDM

 

[Outbound]

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 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.

Pedantry for the win!

 

[lowwall]

@Duke Dive Medicine or @Dr Simon Mitchell ,

Have any of the recommendations changed since the publication of the attached article?

I've pulled out and separately attached the flowchart from the article that provides guidance on when to give in-water rescue breaths.

 

[justinthedeeps]

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?

I am sorry it is confusing that I both credit the merits of PADI course curriculum and its best intentions, but that I also have serious concerns and questions about its design and rigor for real world situations.

I also do not appear to be alone in questioning the very choreographed "exercise 7," the specific details of which are so highly featured as critically important in the course, and pushed so heavily on students (and DMTs) as "you MUST do this perfectly, as we have described, and ONLY this way."

We are questioning whether that does actually make sense from a perspective of actual professional EMS and lifesavers doing real rescues, challenging conditions, etc. Maybe it does, but I would like to know how and why--with examples from actual incidents and rescues, preferably. We are saying this from the perspective of ordinary people, students and even instructor standpoints who have been through the course, and yes did benefit from it.

Unfortunately, nothing in the world is so "black and white"

 

[kinoons]

You'd be putting the diver at an unacceptably high risk of pulmonary barotrauma. We don't use positive pressure ventilation O2 regulators any more for the same reason. Most bag valve masks have pop-off valves and it's much easier to gauge effectiveness with the patient dry and in front of you.

Best regards,
DDM

Also you’re much more likely to inflate the stomach and cause vomiting (this is mistakenly done with a BVM as well, albeit a lower risk). An unresponsive patient vomiting runs the risk of aspiration, so if the distressed diver does survive, they can deal with pneumonia and sepsis on top of the cause of their emergency in the first place.

 

[tursiops]

I am sorry it is confusing that I both credit the merits of PADI course curriculum and its best intentions, but that I also have serious concerns and questions about its design and rigor for real world situations.

I also do not appear to be alone in questioning the very choreographed "exercise 7," the specific details of which are so highly featured as critically important in the course, and pushed so heavily on students (and DMTs) as "you MUST do this perfectly, as we have described, and ONLY this way."

We are questioning whether that does actually make sense from a perspective of actual professional EMS and lifesavers doing real rescues, challenging conditions, etc. Maybe it does, but I would like to know how and why--with examples from actual incidents and rescues, preferably. We are saying this from the perspective of ordinary people, students and even instructor standpoints who have been through the course, and yes did benefit from it.

Unfortunately, nothing in the world is so "black and white"

Why don't you ask PADI.

 

[justinthedeeps]

@lowwall thank you, this is an amazing document! Page 1107 has the answers.

Let me apologize for being a bit hyperbolic in soliciting this kind of nuanced expert discussion...

The unresponsive non-breathing diver is either in a state of respiratory arrest or cardiorespiratory arrest, and the committee believes there is no reliable means of separating these states in water. Rescue breaths alone are unlikely to benefit a victim in full cardiorespiratory arrest, and effective chest compressions cannot be administered in the water. Therefore, any delay in removing the immersed victim to a stable platform allowing full CPR in order to deliver in-water rescue breaths is, in effect, a gamble on the possibility that they are in respiratory but not cardiac arrest.

As discussed above, the committee believes this gamble is worth taking at least in part because, in the absence of early paramedic-level advanced life support, a successful resuscitation from cardiac arrest is extremely unlikely, regardless of management. Nevertheless, there is a need for guidance on when to shift the priority from attempting rescue breaths to removing the victim from the water. The committee considered two key questions in this regard.

The first is whether there is any situation, other than concern about personal safety or an inability to deliver rescue breaths efficiently, in which a trained rescuer would not attempt in-water rescue breaths at all in favor of removing the victim from the water as quickly as possible.

One plausible circumstance might be when rescuer and victim surface immediately adjacent to suitable surface support such that there would be no delay at all initiating assisted retrieval. A relevant observation from actual incidents that have involved members of the committee is that removal of a fully equipped unresponsive scuba diver from the water is difficult and can take minutes. ...

 

[justinthedeeps]

I am curious, are there any surf lifesavers/lifeguards here? Do you give in-water rescue breaths?

My impression is that ideally, procedures usually involve a rigid, mobile, buoyant platform--surfboard, rescue ski, lifesaver paddleboard etc--that the trained rescuer can efficiently bring back to shore. Does a fully inflated, unweighted BCD serve well enough as the substitute? It does not exactly support the head?

 

[Duke Dive Medicine]

@Duke Dive Medicine or @Dr Simon Mitchell ,

Have any of the recommendations changed since the publication of the attached article?

I've pulled out and separately attached the flowchart from the article that provides guidance on when to give in-water rescue breaths.

I'll defer to Simon to comment on updates on his own work. The flowchart needs to be interpreted in context though as does any guidance for situations like this. The flowchart could be interpreted as implying that the fix for any unresponsive diver is rescue breaths, but I don't believe that's the intent. The reality is that if the diver doesn't have a pulse, rescue breathing is highly unlikely to be of benefit. Following the flowchart and administering rescue breaths is doing something that may be of benefit under certain circumstances, that is, the diver has a pulse but is not breathing effectively for some reason, thus is reasonable to do when it's uncertain what caused the diver to become unresponsive. The article expands on this starting at the end of page 1104.

Best regards,
DDM

 

[lowwall]

I'll defer to Simon to comment on updates on his own work. The flowchart needs to be interpreted in context though as does any guidance for situations like this. The flowchart could be interpreted as implying that the fix for any unresponsive diver is rescue breaths, but I don't believe that's the intent. The reality is that if the diver doesn't have a pulse, rescue breathing is highly unlikely to be of benefit. Following the flowchart and administering rescue breaths is doing something that may be of benefit under certain circumstances, that is, the diver has a pulse but is not breathing effectively for some reason, thus is reasonable to do when it's uncertain what caused the diver to become unresponsive. The article expands on this starting at the end of page 1104.

Best regards,
DDM

It's not easy to correctly identify if an unresponsive victim has a pulse in these circumstances, at least for those of us who aren't medical professionals. Rather than take the time to try to find a pulse, unless a boat/dock/land is immediately accessible, I think it would be more logical to give the initial rescue breaths right away and then start looking for your quickest way out of the water.

Even though the chances of it helping are slim, Ithe initial breaths are not going to cause any damage (right?) and only take a few seconds.