Rescue Breathing on the surface

[northen diver]

You should read my post again. I said nothing about CPR. My point was that if the person's heart is not beating doing rescue breaths in the water is a waste of time as no oxygen would be circulating. You should get the person to shore as fast as possible where you can actually do CPR.

As people have pointed out it is quite difficult to determine if a person's heart is beating in the water so it is probably better to do some rescue breaths in the water.

The issue I have with doing rescue breaths in the water is: unless you are well trained on it and practice alot, it is difficult and time consuming process that may or may not have any beneficial effect. If you waste alot of time doing rescue breaths in the water and the heart is not beating you've wasted precious time that could have been used doing CPR on land or boat.

Also as someone else stated, the CPR guidelines have changed or are about to change to increase the compressions to reflect that it is more important to circulate the blood which delivers the oxygen to the brain and other organs.

Perhaps I confused you when I mentioned CPR. The ALA, USLA, YMCA, ARC all teaches deep water rescue breathing on thier rescue training courses. That is why I had put your statement that doing rescue breathing in the water is a waste of time, in bold letters. My point is that all of these agencies teaches this rescue method for a reason. Because it works! Now at what percentage. Who knows. BUT, keep in mind that CPR on land only has a survival rate of 14 percent for BLS.

 

[donooo]

Uh Oh!........Someone had better tell the ALA (American Lifegaurding Association) and the USLA (United States Lifesaving Association), The ARC (American Red Cross), the YMCA's and the various agencies teaching rescue diving classes because ALL of these agencies are teaching this skill. I am no doctor, so I go with my training that I am taught. Is rescue breathing hard in the water while towing a victim? Sure it is. Get trained and practice it often and it'll get easier. Remember, only 14 percent of victims receiving CPR survives. Am I going to use this low percentage as a reason to not to do CPR.

I am both an ARC Instructor and a DAN Instructor, but not a Lifeguard Instructor. I teach the ARC CPR for the Professional Rescuer class that is part of the Lifeguarding Program. In the CPR class there is no discussion of in water Rescue Breathing.
In the ARC Lay responder course and most all dive organization CPR classes, ( EFR and Medic First Aid ) you are taught Lay Responder CPR. That is two breaths and then 30 chest compressions. You are not taught to do rescue breathing alone or to check a pulse.
In the ARC CPR/Pro class or the DAN BLSpro class you are taught to check for a pulse and to do rescue breathing alone. No discussion of in water ventillations.

So what we have is a hole between the old training and the new training that the RSTC has not responded to and some instructors are trying to fill in. If your CPR training tells you that you are not qualified to do rescue breathing alone and your dive Instructor teaches you how to do it then ?????

But, by the way, there is no requirement for your Instructor to be current in CPR anyway. Best bet is to take the higher level of CPR so that you can perform rescue breathing if need be, but drag the victim as fast as you can to shore or a boat and get help.

It has been rumored that RSTC is re evaluating the unconscious diver excersis for both Rescue classes and DM/DCS classes, but until the do,,, there is a hole.

adios don O

 

[northen diver]

Single responder: 20 compressions to 1 breath
Multi responder: 5 compressions to 1 breath

Wrong! Your profile says your interest is medicine and flying. I really hope your not a flight medic.....

30:2 for a single responder AND for a 2 person team.

This is why the compressions changed recently

One study of 176 adults receiving CPR in European cities found that paramedics and nurse anesthetists performed chest compressions “only half of the available time,” reported Lars Wik, MD, PhD, of Ulleval University Hospital in Oslo, Norway, and colleagues. In another study, Lance B. Becker, MD, of University of Chicago Hospitals in Illinois, and colleagues reported that well-trained hospital staff performed inconsistent CPR that frequently did not meet published CPR guideline recommendations.

 

[freediver]

The issue I have with doing rescue breaths in the water is: unless you are well trained on it and practice alot, it is difficult and time consuming process that may or may not have any beneficial effect. If you waste alot of time doing rescue breaths in the water and the heart is not beating you've wasted precious time that could have been used doing CPR on land or boat.

Maybe this IS the issue. I am of the opinion that you SHOULD be well trained in it and practice it alot. If there is any reason to think that the person has a condition that might be corrected in water (respiratory arrest) then rescue breaths could be very beneficial. Why let a potentially correctable condition (respiratory arrest) lead to a very grim condition (cardiac arrest) without the attempt? My qualifying conditions would be a victim of blackout and a limited term immersion.
By the way, to an earlier post, the American Red Cross no longer teaches in-water resuscitation.

 

[northen diver]

I am both an ARC Instructor and a DAN Instructor, but not a Lifeguard Instructor. I teach the ARC CPR for the Professional Rescuer class that is part of the Lifeguarding Program. In the CPR class there is no discussion of in water Rescue Breathing.
In the ARC Lay responder course and most all dive organization CPR classes, ( EFR and Medic First Aid ) you are taught Lay Responder CPR. That is two breaths and then 30 chest compressions. You are not taught to do rescue breathing alone or to check a pulse.
In the ARC CPR/Pro class or the DAN BLSpro class you are taught to check for a pulse and to do rescue breathing alone. No discussion of in water ventillations.

So what we have is a hole between the old training and the new training that the RSTC has not responded to and some instructors are trying to fill in. If your CPR training tells you that you are not qualified to do rescue breathing alone and your dive Instructor teaches you how to do it then ?????

But, by the way, there is no requirement for your Instructor to be current in CPR anyway. Best bet is to take the higher level of CPR so that you can perform rescue breathing if need be, but drag the victim as fast as you can to shore or a boat and get help.

It has been rumored that RSTC is re evaluating the unconscious diver excersis for both Rescue classes and DM/DCS classes, but until the do,,, there is a hole.

adios don O

First off, you had better go back to your local ARC chapter and get updated on your CPR PR AND instructor lifegaurding. It changed six months ago. ARC IS teaching the deep water rescue breathing NOW. YMCA ALS and USLA alway has for years. The ARC was a little behind. The ARC lifeguard also NOW has to be taught O2 admin. also in the new requirements. Go to www. ARC, click on instructor training (your local chapter will give you a password if your an instructor) and you'll see all of the requirements. Also, the instructors dont need to keep taking CPR classes over and over just to teach it. As long as you teach twice a year, your instructor card is good.


PLEASE STOP advocating that rescue breathing is a waste of time. You ARE NOT a doctor are you? All of these agencies are teaching this skill for a reason. Stick to your training. If you disagree with it, so be it, but dont spout off like you KNOW its a waste of time unless you have some real proof.

 

[northen diver]

I am both an ARC Instructor and a DAN Instructor, but not a Lifeguard Instructor. I teach the ARC CPR for the Professional Rescuer class that is part of the Lifeguarding Program. In the CPR class there is no discussion of in water Rescue Breathing.
In the ARC Lay responder course and most all dive organization CPR classes, ( EFR and Medic First Aid ) you are taught Lay Responder CPR. That is two breaths and then 30 chest compressions. You are not taught to do rescue breathing alone or to check a pulse.
In the ARC CPR/Pro class or the DAN BLSpro class you are taught to check for a pulse and to do rescue breathing alone. No discussion of in water ventillations.

So what we have is a hole between the old training and the new training that the RSTC has not responded to and some instructors are trying to fill in. If your CPR training tells you that you are not qualified to do rescue breathing alone and your dive Instructor teaches you how to do it then ?????

But, by the way, there is no requirement for your Instructor to be current in CPR anyway. Best bet is to take the higher level of CPR so that you can perform rescue breathing if need be, but drag the victim as fast as you can to shore or a boat and get help.

It has been rumored that RSTC is re evaluating the unconscious diver excersis for both Rescue classes and DM/DCS classes, but until the do,,, there is a hole.

adios don O

Also, if you are teaching only the CPR-PR portion, the lifegaurd instructor will be teaching the rescue breathing portion of the training since it is a water skill, not the CPR-PR instructor, and another person would teach the O2 admin if the LGI or CPR instructor isnt qualified to teach O2 admin.

 

[ffhamm]

Current American Heart protocol (Most agencies follow current American Heart Standards) is 30:2 for everyone except infants.

Rescue breathing without chest compressions is no longer taught to laypersons.

Provider training states that "Healthcare providers will be taught to deliver rescue breaths without chest compressions for the victim with respiratory arrest and a perfusing rhythm (ie, pulses). Rescue breaths without chest compressions should be delivered at a rate of about 10 to 12 breaths per minute for the adult "

Your rescue diver class probably advocates "rescue breathing" during a suface tow. My *OPINION* is that this *MAY* be a good idea for an extended tow. But on a short surface tow it may be a waste of time. The problem being, that your time to shore/boat will be signifigantly longer (if youve never tried to deliver breaths while towing, give it a go sometime) a patent airway is hard to maintain and a pulsless pt needs chest compressions. Weak/rapid pulses are sometimes hard to find, even on a pt that is laying in a hospital bed. If you know your patient has pulses, you would be helping by giving rescue breaths.

I would do whatever you're taught by whatever agency instructed you. You know you are providing the highest level of care that you are able. I know what I would do.

Not to muddy the water even more, but there are signifigant changes that are driven by several studies that will most likely change cpr soon.


Jeff

 

[donooo]

First off, you had better go back to your local ARC chapter and get updated on your CPR PR AND instructor lifegaurding. It changed six months ago. ARC IS teaching the deep water rescue breathing NOW. YMCA ALS and USLA alway has for years. The ARC was a little behind. The ARC lifeguard also NOW has to be taught O2 admin. also in the new requirements. Go to www. ARC, click on instructor training (your local chapter will give you a password if your an instructor) and you'll see all of the requirements. Also, the instructors dont need to keep taking CPR classes over and over just to teach it. As long as you teach twice a year, your instructor card is good.


PLEASE STOP advocating that rescue breathing is a waste of time. You ARE NOT a doctor are you? All of these agencies are teaching this skill for a reason. Stick to your training. If you disagree with it, so be it, but dont spout off like you KNOW its a waste of time unless you have some real proof.

Go back and read. 1) I said I am not a Life guard Instructor and as you pointed out in your next post, the Lifeguard Instructor teaches in water ventillations. (maybe) 2) Dive Instructors are not automatically re newed in CPR when not teaching CPR classes like Medic First Aid or EFR. An instructor does not get a new CPR cert for teaching Rescue Diver or a DM class. There is no requirement for an instructor or DM/Dive Con to be current 3) Nobody says Rescue Breathing is a waste of time? I said be trained to do it if need be. Take an Advanced class. Each case will be different. If I am 50 feet from a boat messing around with gear and breathing is a wast of time. And by the way, if you have a Lay responder card that says you are not qualified to do rescue breathing only and you screw around "trying" what are the consequences?

don O

 

[markr]

Wrong! Your profile says your interest is medicine and flying. I really hope your not a flight medic.....

30:2 for a single responder AND for a 2 person team.

This is why the compressions changed recently

One study of 176 adults receiving CPR in European cities found that paramedics and nurse anesthetists performed chest compressions “only half of the available time,” reported Lars Wik, MD, PhD, of Ulleval University Hospital in Oslo, Norway, and colleagues. In another study, Lance B. Becker, MD, of University of Chicago Hospitals in Illinois, and colleagues reported that well-trained hospital staff performed inconsistent CPR that frequently did not meet published CPR guideline recommendations.

You are also wrong. The compression-ventilation ratio is not the same for one and two person rescues.

The following quote was copied from the American Heart Association's guidelines for CPR:
" A compression-ventilation ratio of 30:2 is recommended and further validation of this guideline is needed (Class IIa). In infants and children (see Part 11: "Pediatric Basic Life Support"), 2 rescuers should use a ratio of 15:2 (Class IIb)."

The following quote came from the same source and refers to CPR being provided by non-professionals:
"
[SIZE=-1]Compression-Only CPR[/SIZE]
The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest. In surveys healthcare providers as well as lay rescuers were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.
In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation (LOE 3http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-19#R203-166553; 4). Some animal studies (LOE 6) and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR for VF SCA. If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. In addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR. Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths (Class IIa), although the best method of CPR is compressions coordinated with ventilations."



Here's a link to the whole document:

http://circ.ahajournals.org/content/vol112/24_suppl/


The bits I copied are from part 4 Adult Basic Life Support.

 

[Paco II]

Ok, one last fix to this posting.

1. The article referred to is from 2005
2. The comment about 2 rescuers is referring to infants and children.
3. When doing CPR on an adult, it does not matter how many rescuers are involved, it is always 30:2. That is what I was taught in the course I took in May.

You are also wrong. The compression-ventilation ratio is not the same for one and two person rescues.

The following quote was copied from the American Heart Association's guidelines for CPR:
" A compression-ventilation ratio of 30:2 is recommended and further validation of this guideline is needed (Class IIa). In infants and children (see Part 11: "Pediatric Basic Life Support"), 2 rescuers should use a ratio of 15:2 (Class IIb)."

The following quote came from the same source and refers to CPR being provided by non-professionals:
"
[SIZE=-1]Compression-Only CPR[/SIZE]
The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest. In surveys healthcare providers as well as lay rescuers were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.
In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation (LOE 3; 4). Some animal studies (LOE 6) and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR for VF SCA. If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. In addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR. Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths (Class IIa), although the best method of CPR is compressions coordinated with ventilations."



Here's a link to the whole document:

http://circ.ahajournals.org/content/vol112/24_suppl/


The bits I copied are from part 4 Adult Basic Life Support.