Rescue Diver Training Becomes Real Thing!

[Down2bizDiver]

How does the victim feel about you posting his incident on the Internet?

He is OK with it. I showed him all of the raw unedited video while he was recuperating. None of the edited video shows his face, I don't mention his name, where he lives, or any other personally identifying information. We were diving together in the same group for days and he knew I was making videos. I've had no contact with him since we were together at the airport last Saturday, consequently I don't know if he has viewed the final video I posted or whether he has visited ScubaBoard or other dive related sites where links to the video, and comments, have been posted. He does know how to contact me.

I think that had things turned out badly my video would be of even greater interest and value to any number of people who would be thanking me for making it ... or perhaps, not, as you may understand.

Please visit youtube and take a look at my other dive videos - in the youtube search box type "down2biz" and all of my videos should come up. Leave comments there, please. The victim might appear in some of those videos, but you can't identify him because, as you know, divers wear masks! lol

 

[Duke Dive Medicine]

When the doctor was explaining the situation to the group he said that in low psi situations big people, especially big men like Victim and, pointing to me, Down2 who have big chests and powerful muscles can over expand their lungs by expanding their chests in an effort to draw in more air. He said this caused contusion or bruising and associated swelling. This makes perfect sense to me as a layman.

In the phenomena of negative pressure pulmonary edema, enough vacuum is created in the lungs to draw fluid into the interstitial space. This isn't the same as overexpansion of the lungs - that's normally associated with holding the breath on ascent.
Negative pressure pulmonary edema has been described in anesthetized patients who become severely dyssynchronous with the ventilator and in recently extubated patients who develop laryngospasm. It's never been described in a diver who inhales too hard against an empty SCUBA tank, so if this is indeed what happened, this is a very interesting case. I still have my own doubts about it, especially considering that the air in his lungs was expanding as he ascended, but all's well that ends well.

As for the position of the victim on the floor of the boat, he was coughing up fluid, there were three instructors onboard who were in the process of teaching a rescue diver course, and a doctor who dives was there. If what they were doing was not good practice then PADI, DAN and the rest need to get the word out to certified rescue divers and instructors!

In a situation where a near-drowning victim has aspirated water (which you said didn't happen), it may be appropriate to place the victim's head below the feet during ongoing resuscitation efforts. In suspected arterial gas embolism, the appropriate position is left lateral recumbent, also known as the recovery position. In suspected pulmonary edema, it's not appropriate to elevate the feet as this forces more blood into the trunk and could exacerbate the problem. The left lateral Trendelenburg (feet elevated) position for an injured diver has not been taught for a number of years. It's not in any dive rescue manuals, EMS textbooks, or diving medicine textbooks I've seen. Just to double check, I asked one of the DAN training directors today if they were still teaching it, and all he did was give me a funny look. I can't speak to the training of the caregivers on the boat, but the feet-up position is not the standard of care for a suspected diving injury and hasn't been for some time.

Nothing I've written here or in the previous post is intended as a slight to anyone who was there, yourself included. However, when something is posted in a forum like this that shows a diver receiving care that doesn't appear to follow current standards, it's only prudent for me as a medical professional to call attention to it so those viewing the video aren't led to believe that it's ok.

Regards,
DDM

 

[SC_Hoaty]

Were the feet elevated much? It's hard to tell if they are higher than his hips. It does appear his ankles and feet are on something that looks like a BCD, but that may just be some cushioning from the hard deck of the dive boat.

 

[Dr Wu]

He is OK with it. I showed him all of the raw unedited video while he was recuperating. None of the edited video shows his face, I don't mention his name, where he lives, or any other personally identifying information. We were diving together in the same group for days and he knew I was making videos. I've had no contact with him since we were together at the airport last Saturday, consequently I don't know if he has viewed the final video I posted or whether he has visited ScubaBoard or other dive related sites where links to the video, and comments, have been posted. He does know how to contact me.

I think that had things turned out badly my video would be of even greater interest and value to any number of people who would be thanking me for making it ... or perhaps, not, as you may understand.

Please visit youtube and take a look at my other dive videos - in the youtube search box type "down2biz" and all of my videos should come up. Leave comments there, please. The victim might appear in some of those videos, but you can't identify him because, as you know, divers wear masks! lol

I see.

Thank you for such attention to detail.

 

[Down2bizDiver]

I still have my own doubts about it, especially considering that the air in his lungs was expanding as he ascended ...
DDM

He was buddy breathing from a full tank during ascent from depth except for the last approx. 15 feet when he went back onto his own tank but aborted the safety stop after about 1 minute.

 

[BTravlin]

I have to wonder why the dive buddy would continue the safety stop under these circumstances? I would have blown off the remainder of the safety stop and followed my buddy to the surface. Had the buddy done this they could have given valuable assistance until the boat arrived.

 

[Duke Dive Medicine]

He was buddy breathing from a full tank during ascent from depth except for the last approx. 15 feet when he went back onto his own tank but aborted the safety stop after about 1 minute.

I caught that part, sorry, maybe should have been more specific in my post. The air in his lungs when ascending from 15 fsw to the surface would have been expanding and thus would have decreased the chance of negative pressure pulmonary edema. Example: if he started at 15 feet with two liters of air in his lungs, he'd have theoretically come up with about 3 liters due to the air expansion. Much beyond this would be speculation due to all the unknowns... how much air he had in his lungs when he left 15 feet, whether he vented on the way up, whether his regulator gave him more air with decreasing depth, whether he had time to get hypercapnic and start "contracting" (involuntary inhalation attempts), etc.
Cheers,
DDM