Yesterday I had the misfortune of being involved in a diver rescue and I want to share a couple of insights.
First a quick overview of the incident:
- a pair of divers surfaces and are clearly in disagreement about something. Suddenly, diver #1 turns toward shore (where we were standing) and starts waving and calling for help. Diver #2 is still there. He does not appear to be injured or in distress and he does not attempt to help diver #1 or to assist in raising the alarm.
- Our group decides to send two divers to see what is happening. Upon reaching Diver #1 they have a very short conversation with her and then yell to alert the EMS. They immediately descend after that.
- Divers #1 and #2 swim to shore. Diver #1 is hysterical. Her buddy is missing and (in her words) "laying on the bottom". Diver #2 still appears completely unaffected by events.
- The first EMS unit arrives very quickly and two more divers go in the water to start searching. A boat and a helicoptor are also arriving. All of this amazing amount of material arrived within 5-odd minutes of the first two divers decending. Someone with a snorkel has starting swimming back and forth over the dive area and is taking charge on the surface. All divers nearby are either told to get ready to assist in the search or to get out of the water.
- After about 10 minutes the first two divers arrive back on the surface with the victim. They start rescue breaths and start to remove his equipment. The boat now carrying paramedics goes to meet them and the victim is transferred to the boat. At this point two more divers are searching independently but are obviously unaware of events on the surface.
- After another 10-15 minutes, the two divers still on the bottom decide to split up and continue searching at different depths because one of the pair started with a tank that was not full and is getting low on air. 10 minutes later the low-on-air diver surfaces and 15-20 minutes later the last diver surfaces. This pair did locate some of the diver's equipment but obviously did not find the victim.
========================
Observations / lessons learned
========================
1) Raising the alarm. When diver #1 started to call for help there was initial confusion on shore as to whether or not this was an excercise or something real. This was exacerbated by the fact that Diver #2 was still with her but not doing anything. This resulted in the dive team taking a short time to deliberate (trying to figure out if she was serious or if it was an excercise) before deciding to commit. In theory, a raised alarm is a clear cut thing. In practice it might not be the case. Lesson learned here is that this cost us time and it would have been better in retrospect to send divers directly into the water and decide *after* talking to Diver #1 if further action was necessary.
2) One of the things we did right initially was to send two divers in full scuba into the water right away. I know some instructors say to students in the rescue course that it can be a good idea to first send snorkelers to a distressed diver on the surface because it's quicker. However, I'm now more convinced than ever that sending snorkelers into the water is the SECOND priority in most cases and *certainly* in cases where the diver on the surface is clearly not the diver who needs help. If we had sent snokelers into the water first it would have cost us badly in lost time.
3) We decided not to alert the EMS before talking to Diver #1. Once it was clear what was happening the rescuers signed back to shore first and the YELLED back to shore second to alert the EMS. It didn't lose us any time but in retrospect it would have been best if we had had a clear sign for engaging the EMS *before* the divers had to work it out on the fly. It would have just been one more thing that was clear in a situation that started out tentitively and accelerated very quickly once we were sure things were serious.
4) Coordination on the surface was intially performed by the snorkeler who was #3 in the water and watching bubbles. However, once the victim was out of the water this snorkeler left with the paramedics. Everyone became "tunnel visioned" on the victim. The two rescuers who had just recovered the victim were left floating on the surface with no form of support when the boat left. The two divers on the bottom were forgotten completely. The snorkeller would have seen that they had split up and could have maintained control of the situation by monitoring their bottom time until they surfaced but none of this happened. When the last diver (in this case me) surfaced, the entire dive area was deserted and only my OW students where standing on shore wondering where I was. Two lessons here. First it was very helpful to have a snorkeler coordinating activity on the surface because it was all unfolding very quickly. There was a lot of noise, sirens, helicoptors, people running around, crowds forming and this snorkeller in the water with the big picture. This was a good start but missed the follow-through. The second lesson (obviously) is that the surface support needs to stay in place until all of the divers are accounted for. In theory it's easy to understand this. In practice, people being what they are, will focus all of their energy on helping the victim which can cause loss of task focus.
4b) In terms of procedures like having clear cut search plans, agreed upon dive times and diver recall signals (like banging a hammer on the bottom of the boat, for example), in theory it's all nice but when something like this unfolds then it unfolds with the speed of a fart in a tornado and getting a random group of strangers on the same page with these things in a hurry is simply NOT-going-to-happen. The communication overhead involved in keeping people coordinated on this level would take WAY too much energy and I'm convinced that it still wouldn't work unless you had time to practice it first. Your best bet is to keep search teams small (several 2 person teams) and to put divers on the bottom who know the site well and stay calm and keep thinking under pressure. Secondly, put one person in the water with a snorkel to coordinate on the surface and keep the chaos in the water to a minimum. We ended up doing this (by chance more than by design) and it was fairly effective on the whole even with the sloppy follow-though on the surface support.
5) Once lifted, the victim was ejecting frothy blood from his mouth, presumably from a lung barotrauma or possibly resulting from a heart attack. The rescuers were not prepared for this at all and although they ventilated him, they both said after the fact that it would have been nice if they had been told about this possibility before so they could have been mentally better prepared.
6) It was enormously helpful to have a boat available and it saved a *lot* of time getting the victim out of the water. We didn't acutally request this, someone who heard the ambulance coming jumped into his boat and just came. In retrospect it would have been good to have sent a runner looking for volunteers with a boat but we didn't do that. This was just good luck, I'm afraid to say.
7) Just before I entered the water I saw someone addressing my OW students and went to see what was going on. He was telling them to get their stuff on and get involved in the search. I asked him (impolitely, I'm afraid) if he had asked these divers which certification level they had. I then had to stress to my students before going further that under *no* circumstances were they to get involved regardless of what anyone said to them. At that point (goes to show you how confusing things initially were), one of my students still asked me if this was an excercise ..... Go figure. The obvious message his is that IF you're involved in something like this then for crying out loud, keep your head and make sure you know what people are capable of before you start to order them around. When I decended with that other diver (who I had just met moments before) to go searching, I knew his certification level, deco-status, tank pressure and had a basic understanding of his familiarity with the dive site before we were under water. It only took me 15 seconds to ask these questions. You just can't afford to overlook this stuff or (a) you're going to make mistakes taht cost time and (b) you're going to put people at risk who are not prepared for the task.
8) Still wondering what happened to Diver #2? Nobody seemed to give it much thought at the time because he appeared calm (albeit subdued) but in fact, this was the DM who had been leading the dive and had just seen one of the people under his charge have some kind of major problem that lead to him drowning. In fact, Diver #2 wasn't calm at all. He was in such a massive state of shock that he collapsed after the fact and had to be taken away by the paramedics. The initial "disagreement" that we saw was in fact Diver #1 screaming at him to do something but he was too stunned to even respond. Remember passive panic from the Rescue course? We all missed it.
9) Finally, up until we actually found the victim most of us were *still* working on the assumption that he would surface somewhere else and this whole thing would just end in a big false alarm. The rescuers who found the victim said repeatedly after the fact that it was all "surrealistic" as if it wasn't happening or wasn't serious at all. Once they had the diver on the surface and they saw the blood and they saw how blue he had become they also thought that it was completely pointless to even try reanimating him. I can imagine that a lot of other people would have given up at this point and declared it a lost cause but in fact, the victim *was* reanimated and is still alive now 36 hours after we plucked him up off the bottom. It's still unclear if he's going to make a full recovery or how bad any brain damage will be but by working through this feeling that it wasn't really happening and that it was all pointless the rescue, at least, was successful. I think this surrealistic feeling is a natural human reaction to potentially traumatic events and it probably deserves more air-time in the rescue course.
I don't know how many people on scubaboard have real world experience with rescues like this but it sure showed us a few differences between theory and practice that I thought were important enough to post about. If anyone else has similar insights I'd like to hear them. I hope this is the right part of the forums for this. If not, please move it.
R..
First a quick overview of the incident:
- a pair of divers surfaces and are clearly in disagreement about something. Suddenly, diver #1 turns toward shore (where we were standing) and starts waving and calling for help. Diver #2 is still there. He does not appear to be injured or in distress and he does not attempt to help diver #1 or to assist in raising the alarm.
- Our group decides to send two divers to see what is happening. Upon reaching Diver #1 they have a very short conversation with her and then yell to alert the EMS. They immediately descend after that.
- Divers #1 and #2 swim to shore. Diver #1 is hysterical. Her buddy is missing and (in her words) "laying on the bottom". Diver #2 still appears completely unaffected by events.
- The first EMS unit arrives very quickly and two more divers go in the water to start searching. A boat and a helicoptor are also arriving. All of this amazing amount of material arrived within 5-odd minutes of the first two divers decending. Someone with a snorkel has starting swimming back and forth over the dive area and is taking charge on the surface. All divers nearby are either told to get ready to assist in the search or to get out of the water.
- After about 10 minutes the first two divers arrive back on the surface with the victim. They start rescue breaths and start to remove his equipment. The boat now carrying paramedics goes to meet them and the victim is transferred to the boat. At this point two more divers are searching independently but are obviously unaware of events on the surface.
- After another 10-15 minutes, the two divers still on the bottom decide to split up and continue searching at different depths because one of the pair started with a tank that was not full and is getting low on air. 10 minutes later the low-on-air diver surfaces and 15-20 minutes later the last diver surfaces. This pair did locate some of the diver's equipment but obviously did not find the victim.
========================
Observations / lessons learned
========================
1) Raising the alarm. When diver #1 started to call for help there was initial confusion on shore as to whether or not this was an excercise or something real. This was exacerbated by the fact that Diver #2 was still with her but not doing anything. This resulted in the dive team taking a short time to deliberate (trying to figure out if she was serious or if it was an excercise) before deciding to commit. In theory, a raised alarm is a clear cut thing. In practice it might not be the case. Lesson learned here is that this cost us time and it would have been better in retrospect to send divers directly into the water and decide *after* talking to Diver #1 if further action was necessary.
2) One of the things we did right initially was to send two divers in full scuba into the water right away. I know some instructors say to students in the rescue course that it can be a good idea to first send snorkelers to a distressed diver on the surface because it's quicker. However, I'm now more convinced than ever that sending snorkelers into the water is the SECOND priority in most cases and *certainly* in cases where the diver on the surface is clearly not the diver who needs help. If we had sent snokelers into the water first it would have cost us badly in lost time.
3) We decided not to alert the EMS before talking to Diver #1. Once it was clear what was happening the rescuers signed back to shore first and the YELLED back to shore second to alert the EMS. It didn't lose us any time but in retrospect it would have been best if we had had a clear sign for engaging the EMS *before* the divers had to work it out on the fly. It would have just been one more thing that was clear in a situation that started out tentitively and accelerated very quickly once we were sure things were serious.
4) Coordination on the surface was intially performed by the snorkeler who was #3 in the water and watching bubbles. However, once the victim was out of the water this snorkeler left with the paramedics. Everyone became "tunnel visioned" on the victim. The two rescuers who had just recovered the victim were left floating on the surface with no form of support when the boat left. The two divers on the bottom were forgotten completely. The snorkeller would have seen that they had split up and could have maintained control of the situation by monitoring their bottom time until they surfaced but none of this happened. When the last diver (in this case me) surfaced, the entire dive area was deserted and only my OW students where standing on shore wondering where I was. Two lessons here. First it was very helpful to have a snorkeler coordinating activity on the surface because it was all unfolding very quickly. There was a lot of noise, sirens, helicoptors, people running around, crowds forming and this snorkeller in the water with the big picture. This was a good start but missed the follow-through. The second lesson (obviously) is that the surface support needs to stay in place until all of the divers are accounted for. In theory it's easy to understand this. In practice, people being what they are, will focus all of their energy on helping the victim which can cause loss of task focus.
4b) In terms of procedures like having clear cut search plans, agreed upon dive times and diver recall signals (like banging a hammer on the bottom of the boat, for example), in theory it's all nice but when something like this unfolds then it unfolds with the speed of a fart in a tornado and getting a random group of strangers on the same page with these things in a hurry is simply NOT-going-to-happen. The communication overhead involved in keeping people coordinated on this level would take WAY too much energy and I'm convinced that it still wouldn't work unless you had time to practice it first. Your best bet is to keep search teams small (several 2 person teams) and to put divers on the bottom who know the site well and stay calm and keep thinking under pressure. Secondly, put one person in the water with a snorkel to coordinate on the surface and keep the chaos in the water to a minimum. We ended up doing this (by chance more than by design) and it was fairly effective on the whole even with the sloppy follow-though on the surface support.
5) Once lifted, the victim was ejecting frothy blood from his mouth, presumably from a lung barotrauma or possibly resulting from a heart attack. The rescuers were not prepared for this at all and although they ventilated him, they both said after the fact that it would have been nice if they had been told about this possibility before so they could have been mentally better prepared.
6) It was enormously helpful to have a boat available and it saved a *lot* of time getting the victim out of the water. We didn't acutally request this, someone who heard the ambulance coming jumped into his boat and just came. In retrospect it would have been good to have sent a runner looking for volunteers with a boat but we didn't do that. This was just good luck, I'm afraid to say.
7) Just before I entered the water I saw someone addressing my OW students and went to see what was going on. He was telling them to get their stuff on and get involved in the search. I asked him (impolitely, I'm afraid) if he had asked these divers which certification level they had. I then had to stress to my students before going further that under *no* circumstances were they to get involved regardless of what anyone said to them. At that point (goes to show you how confusing things initially were), one of my students still asked me if this was an excercise ..... Go figure. The obvious message his is that IF you're involved in something like this then for crying out loud, keep your head and make sure you know what people are capable of before you start to order them around. When I decended with that other diver (who I had just met moments before) to go searching, I knew his certification level, deco-status, tank pressure and had a basic understanding of his familiarity with the dive site before we were under water. It only took me 15 seconds to ask these questions. You just can't afford to overlook this stuff or (a) you're going to make mistakes taht cost time and (b) you're going to put people at risk who are not prepared for the task.
8) Still wondering what happened to Diver #2? Nobody seemed to give it much thought at the time because he appeared calm (albeit subdued) but in fact, this was the DM who had been leading the dive and had just seen one of the people under his charge have some kind of major problem that lead to him drowning. In fact, Diver #2 wasn't calm at all. He was in such a massive state of shock that he collapsed after the fact and had to be taken away by the paramedics. The initial "disagreement" that we saw was in fact Diver #1 screaming at him to do something but he was too stunned to even respond. Remember passive panic from the Rescue course? We all missed it.
9) Finally, up until we actually found the victim most of us were *still* working on the assumption that he would surface somewhere else and this whole thing would just end in a big false alarm. The rescuers who found the victim said repeatedly after the fact that it was all "surrealistic" as if it wasn't happening or wasn't serious at all. Once they had the diver on the surface and they saw the blood and they saw how blue he had become they also thought that it was completely pointless to even try reanimating him. I can imagine that a lot of other people would have given up at this point and declared it a lost cause but in fact, the victim *was* reanimated and is still alive now 36 hours after we plucked him up off the bottom. It's still unclear if he's going to make a full recovery or how bad any brain damage will be but by working through this feeling that it wasn't really happening and that it was all pointless the rescue, at least, was successful. I think this surrealistic feeling is a natural human reaction to potentially traumatic events and it probably deserves more air-time in the rescue course.
I don't know how many people on scubaboard have real world experience with rescues like this but it sure showed us a few differences between theory and practice that I thought were important enough to post about. If anyone else has similar insights I'd like to hear them. I hope this is the right part of the forums for this. If not, please move it.
R..
