Question PADI Rescue Diver Chest compressions

[happy-diver]

Like a series of compressive bearhugs and a bit of a slap around and tell them you're sorry later
but I'm big with enveloping arms and demeanour

 

[justinthedeeps]

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

So this combined with the article explains why the immediate in-water breaths. The victim might just literally need a breath or two--respiratory arrest--in which case you might even bring them around and have a [semi]-conscious breathing victim before you finish extraction.

Whereas in cardiac arrest or arterial gas emboli, there will typically not be success by any means without a defibrillator and professional EMTs within ~five minutes away.

This clears up a lot of confusion that arises in courses, during which the presumption is made that we are doing some kind of totally ineffective in-water CPR. It doesn't sound like that is the point at all. Was there something in a course booklet explaining this? I don't remember seeing it.

Ironically in light of the first post, the real reason for the in-water breaths in fact does sound very much like the freediving context, where the #1 expected situation is a dry blackout that can be immediately recovered via airway protection and rescue breaths.

 

[Duke Dive Medicine]

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, the initial breaths are not going to cause any damage (right?) and only take a few seconds.

Agree.

Best regards,
DDM

 

[Duke Dive Medicine]

Whereas in cardiac arrest or arterial gas emboli, there will typically not be success by any means without a defibrillator and professional EMTs within ~five minutes away.

Small point but worth expanding on: gas embolism does not necessarily lead to cardiac arrest. None of the AGE patients I've cared for have needed immediate resuscitation.

Best regards,
DDM

 

[boulderjohn]

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.

PADI teaches that it is too hard to detect a pulse under those conditions, so there is no point in trying.

 

[boulderjohn]

Whereas in cardiac arrest or arterial gas emboli, there will typically not be success by any means without a defibrillator and professional EMTs within ~five minutes away.

If you find an unresponsive diver in the water and do everything perfectly, it is still unlikely to have a positive result. In cases of cardiac arrest, that is true on land and much more so in water. The first aid course I taught emphasizes that so that the failed rescuer is not burdened with a feeling of guilt.

 

[Outbound]

This clears up a lot of confusion that arises in courses, during which the presumption is made that we are doing some kind of totally ineffective in-water CPR. It doesn't sound like that is the point at all. Was there something in a course booklet explaining this? I don't remember seeing it.

I think there is a disconnect between what the PADI course materials state (the manual and the eLearning version) and what Rescue Exercise 7 actually has students practice.

The course materials do reflect the flowchart developed by Dr. Mitchell et al. In Section Four, subsection "Responding to Diver Emergencies IV," the materials state that if surface support is less than about 5 minutes away, perform rescue breaths while towing the diver. If support is more than about 5 minutes away, then perform rescue breaths for 1-2 minutes while monitoring for signs of a response to the ventilations. If there is a response but a continued absence of spontaneous breathing, then tow while providing rescue breaths. If there is no response at all, then favor speed over rescue breaths.

The problem I have is that, for what is arguably the most critical information and skills in the entire course, the important nuances of the approach are lost when it comes to the practical application section: Exercise 7. That exercise has students go through a scenario where they are towing while providing rescue breaths. That's good, but I would like to see all three of the above scenarios broken down into separate exercises to really emphasize that in a real-world situation a rescuer is going to have to make on-the-fly assessments and respond accordingly.

I would also like a better explanation of why and when to remove weights and BCDs. It makes towing faster, but at the expense of some upfront time. Is that the right decision to make? Maybe, maybe not, depending on a host of factors. If removing the BCDs is the decision that is made, should it be done all at once and as quickly as possible so that the rescuer can return to ventilations and towing, or should it be done in small, frantic steps in between sets of rescue breaths while trying not to drip water into the victim's airway while faffing about? I don't know the answer to this. My inclination would be to give a set of rescue breaths and then remove gear (or at least one set) as quickly as possible, even if it took a little longer than 5 seconds to do so. But I don't know if this is the correct answer. Is it better to go a little longer than 5 seconds between sets of rescue breaths in favor of a faster tow to surface support, or is it better to ensure ventilations occur every 5 seconds even if it means more time until you get to surface support?

In short, a LOT of nuance is lost when you tell students one set of information in the course materials but then practice for only a single response in the actual in-water class.

 

[boulderjohn]

I think there is a disconnect between what the PADI course materials state (the manual and the eLearning version) and what Rescue Exercise 7 actually has students practice.

The course materials do reflect the flowchart developed by Dr. Mitchell et al. In Section Four, subsection "Responding to Diver Emergencies IV," the materials state that if surface support is less than about 5 minutes away, perform rescue breaths while towing the diver. If support is more than about 5 minutes away, then perform rescue breaths for 1-2 minutes while monitoring for signs of a response to the ventilations. If there is a response but a continued absence of spontaneous breathing, then tow while providing rescue breaths. If there is no response at all, then favor speed over rescue breaths.

The problem I have is that, for what is arguably the most critical information and skills in the entire course, the important nuances of the approach are lost when it comes to the practical application section: Exercise 7. That exercise has students go through a scenario where they are towing while providing rescue breaths. That's good, but I would like to see all three of the above scenarios broken down into separate exercises to really emphasize that in a real-world situation a rescuer is going to have to make on-the-fly assessments and respond accordingly.

I would also like a better explanation of why and when to remove weights and BCDs. It makes towing faster, but at the expense of some upfront time. Is that the right decision to make? Maybe, maybe not, depending on a host of factors. If removing the BCDs is the decision that is made, should it be done all at once and as quickly as possible so that the rescuer can return to ventilations and towing, or should it be done in small, frantic steps in between sets of rescue breaths while trying not to drip water into the victim's airway while faffing about? I don't know the answer to this. My inclination would be to give a set of rescue breaths and then remove gear (or at least one set) as quickly as possible, even if it took a little longer than 5 seconds to do so. But I don't know if this is the correct answer. Is it better to go a little longer than 5 seconds between sets of rescue breaths in favor of a faster tow to surface support, or is it better to ensure ventilations occur every 5 seconds even if it means more time until you get to surface support?

In short, a LOT of nuance is lost when you tell students one set of information in the course materials but then practice for only a single response in the actual in-water class.

I am certified to coach a couple of sports at a high level by national coaching organizations, and both emphasize several key concepts. One of the most important things is that students/athletes will barely remember what you TELL them, but they will readily remember what they practice. The two should not conflict. When you analyze what people are taught to do through their physical actions during practice, you will often see that they are learning something that is incorrect because the practice sets up a situation that conflicts with reality.

I recently spent time pointing out that CESA practice conflicts with the reality of CESA in the real world. Another example is OW instruction. Students are TOLD never to use the inflator hose to begin an ascent. Then they do pool sessions in which they perform skills in the deep end while overweighted and on their knees. At the end of each such session, they ascend, meaning they must first use their inflator hose to inflate their BCDs.

I feel more than one part of the Rescue class has this problem.

 

[tursiops]

I think there is a disconnect between what the PADI course materials state (the manual and the eLearning version) and what Rescue Exercise 7 actually has students practice.

The course materials do reflect the flowchart developed by Dr. Mitchell et al. In Section Four, subsection "Responding to Diver Emergencies IV," the materials state that if surface support is less than about 5 minutes away, perform rescue breaths while towing the diver. If support is more than about 5 minutes away, then perform rescue breaths for 1-2 minutes while monitoring for signs of a response to the ventilations. If there is a response but a continued absence of spontaneous breathing, then tow while providing rescue breaths. If there is no response at all, then favor speed over rescue breaths.

The problem I have is that, for what is arguably the most critical information and skills in the entire course, the important nuances of the approach are lost when it comes to the practical application section: Exercise 7. That exercise has students go through a scenario where they are towing while providing rescue breaths. That's good, but I would like to see all three of the above scenarios broken down into separate exercises to really emphasize that in a real-world situation a rescuer is going to have to make on-the-fly assessments and respond accordingly.

I would also like a better explanation of why and when to remove weights and BCDs. It makes towing faster, but at the expense of some upfront time. Is that the right decision to make? Maybe, maybe not, depending on a host of factors. If removing the BCDs is the decision that is made, should it be done all at once and as quickly as possible so that the rescuer can return to ventilations and towing, or should it be done in small, frantic steps in between sets of rescue breaths while trying not to drip water into the victim's airway while faffing about? I don't know the answer to this. My inclination would be to give a set of rescue breaths and then remove gear (or at least one set) as quickly as possible, even if it took a little longer than 5 seconds to do so. But I don't know if this is the correct answer. Is it better to go a little longer than 5 seconds between sets of rescue breaths in favor of a faster tow to surface support, or is it better to ensure ventilations occur every 5 seconds even if it means more time until you get to surface support?

In short, a LOT of nuance is lost when you tell students one set of information in the course materials but then practice for only a single response in the actual in-water class.

I think you are correct. The Rescue class should be a week long and include all possible exercises plus multiple relevant scenarios. And preferably taught by an instructor with at least EMT credentials.

Do you think anybody would take (and pay for) the class, and any shop would offer it?

 

[Duke Dive Medicine]

I think there is a disconnect between what the PADI course materials state (the manual and the eLearning version) and what Rescue Exercise 7 actually has students practice.

The course materials do reflect the flowchart developed by Dr. Mitchell et al. In Section Four, subsection "Responding to Diver Emergencies IV," the materials state that if surface support is less than about 5 minutes away, perform rescue breaths while towing the diver. If support is more than about 5 minutes away, then perform rescue breaths for 1-2 minutes while monitoring for signs of a response to the ventilations. If there is a response but a continued absence of spontaneous breathing, then tow while providing rescue breaths. If there is no response at all, then favor speed over rescue breaths.

The problem I have is that, for what is arguably the most critical information and skills in the entire course, the important nuances of the approach are lost when it comes to the practical application section: Exercise 7. That exercise has students go through a scenario where they are towing while providing rescue breaths. That's good, but I would like to see all three of the above scenarios broken down into separate exercises to really emphasize that in a real-world situation a rescuer is going to have to make on-the-fly assessments and respond accordingly.

I would also like a better explanation of why and when to remove weights and BCDs. It makes towing faster, but at the expense of some upfront time. Is that the right decision to make? Maybe, maybe not, depending on a host of factors. If removing the BCDs is the decision that is made, should it be done all at once and as quickly as possible so that the rescuer can return to ventilations and towing, or should it be done in small, frantic steps in between sets of rescue breaths while trying not to drip water into the victim's airway while faffing about? I don't know the answer to this. My inclination would be to give a set of rescue breaths and then remove gear (or at least one set) as quickly as possible, even if it took a little longer than 5 seconds to do so. But I don't know if this is the correct answer. Is it better to go a little longer than 5 seconds between sets of rescue breaths in favor of a faster tow to surface support, or is it better to ensure ventilations occur every 5 seconds even if it means more time until you get to surface support?

In short, a LOT of nuance is lost when you tell students one set of information in the course materials but then practice for only a single response in the actual in-water class.

You're giving voice to what happens when recommendations from medical and diving experts that are based on best available evidence are turned into education that is designed for divers of a variety of experience and prior training, possibly without putting those recommendations into context.

To your question about weight/gear removal and timing of breathing, IMHO there's no single answer but the biggest deciding factors are how close you are to help and a dry platform on which to better assess and resuscitate the diver, and whether the gear is keeping the diver afloat (e.g. in high seas) or impeding rescue.

Best regards,
DDM