Rescue Diver Questions...

[muddiver]

I can honestly say that is the first time I have heard/read that approach for bringing someone off the bottom. Personally, I think dumping someone's weight and riding them up is a recipe for disaster. In my cold water wetsuit setup with an AL80 tank, I am wearing about 26 LBS. Dumping all of that weight would make for an interesting Polaris missile. No matter how much air you dump from my BCD and yours, there is no way you are going to offset the 26 LBS.

I prefer not to add air to the victim's BCD. You should be neutral when you find the diver. If it is a lost diver, then he/she should already have some air in their BCD. It might come down to needing to add some air to physically move the person (like double last neutral in 20 feet but found at 100 feet).

The problem with your reasoning is that the neoprene of a wet suit will not expand nearly as much as the air bubble in a BC will. Thus your wet suit will not add as much buoyancy as an expanding air bubble (i.e. a BC with some air in it).

My other point is that even if you exceed the ever-so-sluggest ascent rate of 30 feet per minuite, it is hightly unlikely that you will get bent from that one exposure. If you hold your breath as you go up, then yes, you will experience extream pain followed by unconciousness.

The point of a rescue is to get the casualty to the surface and air in their lungs as soon as possible. People die from lack of oxygen, not lack of immedeate decompression.

You also didn't bother to read/address the comment to release the casualty if you feel the buoyancy is getting out of control.

 

[DBailey]

The problem with your reasoning is that the neoprene of a wet suit will not expand nearly as much as the air bubble in a BC will. Thus your wet suit will not add as much buoyancy as an expanding air bubble (i.e. a BC with some air in it).

My other point is that even if you exceed the ever-so-sluggest ascent rate of 30 feet per minuite, it is hightly unlikely that you will get bent from that one exposure. If you hold your breath as you go up, then yes, you will experience extream pain followed by unconciousness.

The point of a rescue is to get the casualty to the surface and air in their lungs as soon as possible. People die from lack of oxygen, not lack of immedeate decompression.

You also didn't bother to read/address the comment to release the casualty if you feel the buoyancy is getting out of control.

At this moment, I don't care about the wetsuit. The only reason the wetsuit is mentioned is to give a reason for wearing 26 lbs of lead. You just dropped 26 lbs of lead from me. At depth, I might need a quick burst or two in my BCD to become neutral; therefore, the loss of 26 lbs of lead would make me VERY positively buoyant. Why even mess with trying to "ride" them, with this method you should just let them rocket to the surface anyway. Meanwhile, the victim might be face-up, face-down, or sideways on the surface. Two of the three positions are still waiting for you to make your safe ascent before you can get the victim face-up. Granted this assumes you can ascend directly to the victim and that the victim doesn't drift away.

Now matter what way you do the ascent, the rescuer needs to ascend safely. Whether the victim is with the rescuer during the ascent doesn't really matter in terms of air delivery since delivery won't start until both are on the surface AND together. Personally, I would like to be more in control of the situation throughout the entire ascent rather than emploing a method that to me nearly guarantees victim-rescuer seperation.

 

[Jim Lapenta]

I dump the vics air and use my bc to provide lift. It is easier to control the rate. Then dump their weights as soon as we hit the surface. Unless they have it distributed between a belt and say integrated. Then I may dump one of their pockets before starting the ascent. But if it's all or nothing it's nothing till we hit the surface.

 

[DeepSeaDan]

...before - here it is again. hope it helps.


Adaptability is key...

IMO, the most common sense approach to emergency response is to remember to refrain from locking one's thinking inside a box ( sorry, that metaphor is grossly over-used! ), by that I mean one must be able to adapt procedures to varying situations. Equally important is to remember your priorities:

> YOUR ( Rescuer ) safety comes absolutely FIRST.

> People live & die by way of A B C & bleeding.

With those primary criteria in mind, react as safely & as quickly as you can. With open circuit equipment, an "unconcious" casualty is likely a " v.s.a." ( vital signs absent ) casualty ( an exception could be a witnessed O2 tox. victim, where the buddy takes control instantly & protects the diver's airway while surfacing...), who has likely drowned. Such a casualty needs the surface & a flat, hard platform ( for resucitation ) as quickly as can be safely managed.

How you achieve your primary objectives can be analogised to a mechanic with a box full of tools, where you are the "Rescue Mechanic", & your "tool box" is your mind's store of retrievable procedural options, adapted to the circumstances you find yourself in.

As to your scenario of retrieving an "unconcious" casualty underwater, consider these thoughts:

> nature of casualty ( who is it? your buddy? An unknown diver you "happened upon?" )

If it is your buddy, you should have a good idea of the circumstances of their unconciousness, provided you were " buddy diving" - not "kinda diving together". You would then base your response on the known circumstances. Much of what you do will be based on your knowledge of your own personal capabilities & limitations. You MUST be honest with yourself, or risk personal injury in trying to do things beyond your limits. This may include allowing a casualty an unescorted trip to the surface because a controlled ascent together was beyond your abilities. Many a well-intentioned rescuer has suffered the consequences of striving to assist beyond what they can safely achieve, often with tragic results. Resist.

If you "happen upon" an unresponsive diver, they have likely drowned. You now must first consider your own circumstances:

> what is my buddy & mine's dive schedule? ( that's right - you SHOULD have another person along to assist in recovering this person to surface! ).

> How do "we" safely, effectively, get this person to the surface?

You priorities are now:

> your safety
> their airway ( protect it as best you can )
> their buoyancy ( control it as best you can )
> the surface ( as quickly & safely as possible )

Once on surface:

> all get positive

> check breathing. No breathing? Try several rescue breaths as best you can, if there is no response to ventillations, then...

...decide - how close is an adequate platform for c.p.r.? If your close, make all speed for it ( I personally wouldn't slow our speed up by trying to breathe for the casualty en route - they need circulating blood to move any O2 I give them, & I can't move their blood in the water ).

...if said platform is a long way off, tow & breathe for them the best you can, & hope for a miracle.

...then again, hope for a miracle always.

Addendum:

The subject of rescuer(s) positioning is again situation dependent. Two people surfacing an unconcious diver will set up for the lift ( we don't regularly train for this, do we?? ) in a logical fashion where one buddy will control the victim's buoyancy while the other observes/assists from the opposite side. Obviously, buddy co-ordination is key here. If it is a single rescuer scenario, then the same "toolbox" analogy applies. How you achieve the lift will depend on many factors, including: rescuer's personal capabilities, victim's size/ gear config. ( a minimalist rec. diver & a loaded tech. diver are two different animals! ). In many instances, I believe, you will position yourself on the victim's left side, as described in earlier posts. I like to loosen up their left shoulder strap a bit & slip my right forearm through for lifting, while I hold their airway open with my right hand. My left controls their inflator.

What is key is that you remember your priorities & act accordingly.

Best Fishes,
D.S.D.

 

[Crowley]

The PADI rescue course teaches you to make a positively buoyant ascent when surfacing the unresponsive diver. Rescue exercise 6a in confined water is to make a positively buoyant ascent by yourself using your low pressure inflator and maintaining a safe ascent rate. Rescue exercise 6b is to surface the unresponsive diver using positive buoyancy. Done properly it's safe and controlled.

I recommend you use the 'victim's' LPI - that way if you get separated - or indeed, have to let go of the victim - then they will float but you will be in control. The other way around you might have a rapid ascent with the possibility of injuring yourself, and your victim may sink. It doesn't actually matter in terms of the requirements for the course, so find whatever suits you - and it may well depend on the type of inflator.

And I must say VERY strongly - don't ditch somebody's weight underwater unless it's an absolute last resort. Yes, it's better to be bent than dead, but if the victim is simply unconcious and hasn't aspirated any water then if their airway is not open, you risk a lung rupture which in all probability will lead to a crippling or fatal air embolism.

Part of the postion you are taught (upright, with the victims head back) is to maintain an open airway. Any air trapped in the lungs will vent and you reduce the risk of further injury.

Safe diving,

C.

 

[DeepSeaDan]

Yes, it's better to be bent than dead, but if the victim is simply unconcious and hasn't aspirated any water then if their airway is not open, you risk a lung rupture which in all probability will lead to a crippling or fatal air embolism.

...on this idea of an "unconcious" diver. Do you think it likely that they will retain their reg. if unconcious? I doubt it. Even if it stayed in their mouth, they would not be providing the concious effort to retain the seal around the mouthpiece, & would very likely aspirate water.

I checked with the medical mods. on the idea of "persistent laryngospasm" - a condition where, upon aspiration of foriegn matter, the vocal cords spasm closed, effectively blocking the airway. The good doctors agreed this condition would not last long & the cords would relax. This would tend to suggest that lung injury due to overexpansion on ascent is unlikely in the unconcious diving casualty. This is not to suggest the rescuer not make all effort to keep the airway open on ascent. A "chin-on-the-chest" head attitude by the patient may be sufficient to impede air escaping on ascent.

I would agree in most circumstances it would be preferable to leave the casualty's weight system in place; however, regretably, gross overweighting still exists out there & may be the principle cause for a emergency, thus a ditching of the weight may be necessary. This can be quickly assessed during the initial contact with the casualty.

It is also possible the casualty is in the predicament their in due to, regretrably, running out of breathing gas. Now whose buoyancy will control the lift? This is just another reason why simple, fixed protocols may not provide the solution.

I hope to see, in the not-too-distant-future, a quantum shift in the way rescue is taught - a move towards a more dynamic approach to rescue problem solving. I forsee nothing but a benefit for both the rescuer & the casualty.

Regards,
DSD

 

[rstofer]

This whole BC inflation thing is going to depend greatly on context. For cold water, wetsuit, divers, it may take 30# of lift just to be neutral at 100' So, there is no way in the world you can dump both BCs and kick up. In fact, if the victim's BC has failed, there is no way the rescuer's BC will lift them both off the bottom no matter how hard the rescuer kicks. Well, unless the rescuer has a grossly oversized wing.

If you opt to dump their ditchable weight (perhaps 20#), it will be easier to get them off the bottom (again, assuming failed BC) but there won't be any way to slow the ascent as you approach the surface. Unless you are both diving large tanks and they are still full and highly negative.

When I took Rescue in SE Asia, we only wore about 6# of weight and the majority of that was to counteract the change in buoyancy of the Al 80 tank. Rescue was fairly simple.

Then there is the problem of drysuits. How many wetsuit rescuers know how to manipulate a drysuit? I don't. Nor do I know if there is as much change in buoyancy from the bottom to the surface as there is with a wetsuit. If the drysuit puffs up, the victim is on their own! I think the outcome of a wetsuit diver rescuing a drysuit diver will be highly variable.

The whole issue of cold water rescue is quite difficult to generalize, in my opinion. I really don't think there is a 'one size fits all' approach that will produce a satisfactory result. You do the best you can under the circumstances and hope it works out in court.

Richard

 

[Crowley]

Good discussion, I like this.

DeepSeaDan - points well made - and each case will be different. I know of incidents where unconcious divers did indeed retain their regulator, and in one instance a dive buddy attempted a hammy sort of underwater rescue breathing by pressing the victims purge button during ascent. The result? Massive and fatal embolism.

The circumstances in which a diver may be unconcious underwater are of course going to vary and you're right about fixed protocols not being a solution. The OP was talking about a Rescue Course rather than an actual rescue and my recommendation for using the victim's LPI applies to that excercise. If they have run out of air then of course the rescuer will have to use either their own LPI or swim the victim upwards. During my rescue classes I have had the "unconscious" diver simulate this by disconnecting their LPI leaving the rescuer to work around the problem. I have found it a good technique for reinforcing the judgment and problem solving attitude of a rescue student - as in maybe a quick check of the SPG will save time later on. Remember however that this postive buoyancy ascent technique is a required training excercise during the PADI rescue course - so students must be able to do it. Whether it's practical in a real life situation is a different matter.

Many divers who attend rescue classes are relatively inxeperienced and I think the class is fine the way it is, for the purpose it has. It's a good course for people who are interested and it provides a great basic introduction to rescue techniques. I'm not sure the course should be altered significantly, but perhaps an "advanced" rescue course might be the way to go.

With regards ditching the weights - you or I or others may have the experience and judgement to determine if a diver is significantly over-weighted and act as appropriate, however again I would go back to the fact that many Rescue Course participants may not have that experience and therefore I feel that teaching people to ditch weights may actually be problematic - and most certainly not on a simulated "victim"!

And again, I agree with both DSD and rstofer that there is no "one-size-fits-all" approach but if we tried to cover everything we'd be training professional rescue divers, not recreational. I think the best we can do is give advice, teach realistic techniques and discuss and/or practice alternatives whilst encouraging people to think their way around a situation.

Hopefully, it's something most Rescue Divers will never have to put into use.

I like discussions like this!

Safe diving,

C.

 

[DeepSeaDan]

This whole BC inflation thing is going to depend greatly on context. For cold water, wetsuit, divers, it may take 30# of lift just to be neutral at 100' So, there is no way in the world you can dump both BCs and kick up. In fact, if the victim's BC has failed, there is no way the rescuer's BC will lift them both off the bottom no matter how hard the rescuer kicks. Well, unless the rescuer has a grossly oversized wing.

If you opt to dump their ditchable weight (perhaps 20#), it will be easier to get them off the bottom (again, assuming failed BC) but there won't be any way to slow the ascent as you approach the surface. Unless you are both diving large tanks and they are still full and highly negative.

When I took Rescue in SE Asia, we only wore about 6# of weight and the majority of that was to counteract the change in buoyancy of the Al 80 tank. Rescue was fairly simple.

Then there is the problem of drysuits. How many wetsuit rescuers know how to manipulate a drysuit? I don't. Nor do I know if there is as much change in buoyancy from the bottom to the surface as there is with a wetsuit. If the drysuit puffs up, the victim is on their own! I think the outcome of a wetsuit diver rescuing a drysuit diver will be highly variable.

The whole issue of cold water rescue is quite difficult to generalize, in my opinion. I really don't think there is a 'one size fits all' approach that will produce a satisfactory result. You do the best you can under the circumstances and hope it works out in court.

Richard

I wholeheartedly agree that the complexity quotient skyrockets in cold water. After all, you've got cold water ( much reduced dexterity, decreased mobility etc. ), usually poorer visibility, greater weight ( for example, I wear no weights, but my h.p. 130 ft3 doubles are uber-negative! ), and, as you pointed out, the relative complexity of the drysuit itself. Now, add to all that a decked-out technical diver, complete with sling tanks, reels, lighting....you get the picture - a rescue nightmare!

C'mon up to Canada Richard & we'll put you through your cold water rescue paces - under the ice perhaps?!?

DSD

 

[DeepSeaDan]

I know of incidents where unconcious divers did indeed retain their regulator, and in one instance a dive buddy attempted a hammy sort of underwater rescue breathing by pressing the victims purge button during ascent. The result? Massive and fatal embolism.

Yikes! Well-intentioned I suppose, but definitely well outside textbook response. This was the reason EMS disposed of the powered mechanical O2 ventillator of yore - too great a risk of over-pressureization ( and no sense of compliance either ).

Remember however that this postive buoyancy ascent technique is a required training excercise during the PADI rescue course - so students must be able to do it. Whether it's practical in a real life situation is a different matter.

Certainly it should be taught - it is a valuable "tool" in the "toolbox." My point is all about identifying primary outcomes, then teaching problem solving skills to achieve those outcomes in the safest, simplest & efficient means possible.

Many divers who attend rescue classes are relatively inxeperienced

This, I believe, is a travesty. I would advocate divers having considerably greater skills coming into this course than is currently acceptable. Divers need to be confident, proficient & comfortable in their diving before they are ready to handle the potential complexities & risks of rescue.

but perhaps an "advanced" rescue course might be the way to go.

I agree. Basic & Advanced, then perhaps specific "Rescue Clinics" to address things like cold water & technical diving. And what about "refreshers?" Like 1st Aid/CPR, your rescue skills go stale due to ( hopefully! ) infrequency of use. But, like 1st Aid/CPR, there doesn't appear to be any long lineups for recertification.

With regards ditching the weights - you or I or others may have the experience and judgement to determine if a diver is significantly over-weighted and act as appropriate, however again I would go back to the fact that many Rescue Course participants may not have that experience and therefore I feel that teaching people to ditch weights may actually be problematic

Again, I'm speaking about "gross" overweighting; a victim so heavy that despite significant buoyant lift & strenuous finning, there is no upward progress. Rare, but possible, leaving the rescuer no other option. I worry that a novice rescuer would be put in a very stressful situation if they were facing such a scenario.


I'm enjoying this as well.

Regards,
DSD