rescue: underwater unconscious diver at 100ft -what to do?

[DeepSeaDan]

Thanks B.J.D. et. al.,

BTW gentlemen, is their a repository of "really keepable" posts somewhere within the confines of this Board? When D.D. speaks of his "keepers file" I get a severe itch to have a peek in there! If there isn't such a "Board file" availalble, could there be? How about a "best of" section for specific categories? I realize this to be a subjective idea - what I consider a real keeper may be considered by others to be a real "sleeper"! Then again, I think most of us would likely agree on the value of submissions of obvious merit...

What do y'all think?

Regards,
D.S.D.

 

[Wildcard]

Anyone want to explain to me what a "mandatory safety stop" is ?! IF this is a required stop then surely its a decompression stop. IF it isnt a deco stop then surely its optional.

From PADI OW
"A stop made between 10-20 feet, usualy 15 feet for 3 or more minutes at the end of the dive for aditional safety. The safety stop is recomended after all dives and REQUIRED on those greater than 100 feet or those coming within three pressure groups of the NDL."

You can always tell when someone knows what they are talking about as in DSDs post as opposed to someone who reads a book then declaires thenselves an expert. One of the big factors that the lay public fails to understand is in a cardiac arrest, the heart has stoped for a reason.If the human body can't keep it's self working, outside intervention has little chance of changing anything. In the last 20 years of working as a paramedic I have seen only a very few "dead" people walk out of the hospital. A few more that coded in front of me made it also. BLS is just a time buying measure untill ALS can get there. Usualy it's way too late.
In the orginal post, this was a drowning situation as opposed to cardiac arrest. The heart was still beating and will for some time, long enough to get them to the surface and start ventlations. This would be one of the very few situations that I would even consider MtoM in the water.
Your safety is always first.

 

[Puffer Fish]

Thanks B.J.D. et. al.,

BTW gentlemen, is their a repository of "really keepable" posts somewhere within the confines of this Board? When D.D. speaks of his "keepers file" I get a severe itch to have a peek in there! If there isn't such a "Board file" availalble, could there be? How about a "best of" section for specific categories? I realize this to be a subjective idea - what I consider a real keeper may be considered by others to be a real "sleeper"! Then again, I think most of us would likely agree on the value of submissions of obvious merit...

What do y'all think?

Regards,
D.S.D.

If there isn't, there should be. I've made a copy of your post, the very first time I have ever done that. Wish everyone diving could read and understand how valuable your clean, clear approach to a very complex and difficult situation is.

I have a lot more years (NAUI #4186), but am humbled by your knowledge. Nice to have people like you and Wildcard posting on this thread.

 

[DandyDon]

If there isn't, there should be. I've made a copy of your post, the very first time I have ever done that. Wish everyone diving could read and understand how valuable your clean, clear approach to a very complex and difficult situation is.

I have a lot more years (NAUI #4186), but am humbled by your knowledge. Nice to have people like you and Wildcard posting on this thread.

The way I did it was to quote it like I was going to reply, then copy & cut, then send to myself in a PM.

From there, I move it to a Keeper file I set up for PMs. You can set up various folders for PMs, if you have the space. As a supporting member, I have room for 1,000.

I may keep it on my computer's SB folder, too.

 

[Trisha]

The problem with sending the unconscious diver up while I do a safety stop is that, once he is on the surface, the crew will want to begin CPR and leave for medical attention immediately.
Who's gonna drop me a line at 15 feet about that?

Since my dive buddies are my family, it's no question -- we go safely to the surface to minimize decompression sickness and a lung expansion injury (if they might be breathing.) Drowning is the first problem, followed by the other two, and none can be cured underwater.

Now if I just come across someone, have no idea who he is or how he got there, then my buddy and I are going to get him to the surface for his family's sake. Again, nothing can be done for him until he's on the surface.

 

[DA Aquamaster]

If were were talking "safety stop" only, I'd blow that off to get the unconcious diver to the surface immediately. I would also take care to keep his or her airway open and ascend at 60 fpm rather than the slower 30 fpm frequently used currnetly as the extra time could be significant in terms of brain damage. (And then I'd use 02 on the boat if it were available to reduce my risk of DCS.)

If it were an actual deco dive, I'd finish my stop(s) as having two casualties on the surface instead of one does nothing to improve the situation. A lot also depends on why the diver went unconcious and obviously on whether they are still breathing. If they are breathing, the emergency is not quite as great, while if blood is already pouring out every orifice, it's probably a lost cause, so there is a narrow window in the middle somewhere where blowing off some minor deco and going to the surface with the unconcious diver may be worth the risk. I think it's a situation where you need to stay flexible as well as stay realistic - having a massive coronary at 100' is not normally surviveable anyway and it does not, in my opinion, justify risking other lives in the course of a rescue attempt.

Realistically it is going to take a few minutes to get the diver on board start CPR, pull the hook, etc so there is no logic in blowing off a short stop if you have another way to get the diver to the surface (send them up with a just decending diver etc). And if the situation is really dire, you are going to want to air evac them anyway, so you just need to be out of the water by the time the helicopter arrives so the boat can get underway into the wind.

Personally, I would also not waste more than 2 breathes on rescue breathing. If it has not worked in 2 breaths it probably won't and going farther and attempting CPR in the water is ineffective and only serves to delay getting the diver back on the boat where CPR can be done properly.

 

[Wildcard]

If were were talking "safety stop" only, I'd blow that off to get the unconcious diver to the surface immediately. I would also take care to keep his or her airway open and ascend at 60 fpm rather than the slower 30 fpm frequently used currnetly as the extra time could be significant in terms of brain damage. (And then I'd use 02 on the boat if it were available to reduce my risk of DCS.)

If it were an actual deco dive, I'd finish my stop(s) as having two casualties on the surface instead of one does nothing to improve the situation. A lot also depends on why the diver went unconcious and obviously on whether they are still breathing. If they are breathing, the emergency is not quite as great, while if blood is already pouring out every orifice, it's probably a lost cause, so there is a narrow window in the middle somewhere where blowing off some minor deco and going to the surface with the unconcious diver may be worth the risk. I think it's a situation where you need to stay flexible as well as stay realistic - having a massive coronary at 100' is not normally surviveable anyway and it does not, in my opinion, justify risking other lives in the course of a rescue attempt.

Realistically it is going to take a few minutes to get the diver on board start CPR, pull the hook, etc so there is no logic in blowing off a short stop if you have another way to get the diver to the surface (send them up with a just decending diver etc). And if the situation is really dire, you are going to want to air evac them anyway, so you just need to be out of the water by the time the helicopter arrives so the boat can get underway into the wind.

Personally, I would also not waste more than 2 breathes on rescue breathing. If it has not worked in 2 breaths it probably won't and going farther and attempting CPR in the water is ineffective and only serves to delay getting the diver back on the boat where CPR can be done properly.

A popular misconception is that all Coast Guard Helos are ALS capable. Some are, most are not. Just basic EMTs at best. Taking the time to wait for a helo (they don't just launch on request ) transfer the Pt to the helo then transport, off load the Pt before they get ALS care needs to be evaluated on a case by case situation. It may be better to get em to shore where an ALS ambulance can start invasive care. Also flying DCI pts with people that don't know about this stuff ( not all flight crews do, believe it or not) can just exaserbate the problems....This is where local dive time comes into play. What do we have where???
In a drowning it may very well take more than two breaths to get some of the water out of the lungs and air moving. Mo betta to get them out of the water quickly if you can but rescue breathing is worth doing.

 

[Ishie]

I haven't taken the rescue course yet.

If the diver is unconscious and breathing, I'd probably blow the safety stop (providing no deco and close access to help), and hold the reg in the diver's mouth, maintaining airway. Even with increased risk, I'd rather take a mild hit if it means greater potential to save someone's life. Same deal if no breathing but still had heartbeat so long as there was an unobstructed airway. I'd administer rescue breaths on the way to the surface, being VERY careful not to overinflate.

No respirations, no heartbeat or obstructed airway with heartbeat; I'd probably take my time. I'm not going to be able to make a safe ascent in time to save them for no heartbeat, and for the obstructed airway, it's unlikely I can get them to the surface without embolizing them. I'd probably try to administer Heimlich at depth first.

This might all change after a rescue class, but that's my intuitive thing. I know it seems like not putting my own safety first to ditch the safety stop, but I'd honestly rather deal with DCS (providing close access to a boat with O2) rather than spend the rest of my life wondering if that three minutes could have saved a buddy's life. And I know doing this also risks bending my buddy too, but I figure if they're already unconscious underwater, they are already in a situation where things aren't going to get much worse.

If I had significant deco though, no way. No point in killing both of us.

 

[rockjock3]

One more thing I forgot. Taking an unconscious non-breathing diver up from 100ft is realistically only going to be a recovery operation. With a minimum 3 minutes to ascend plus the internal damage caused by the inability to offgas, the person will be gone.
I would loveto be corrected here but I cannot imagine a successful rescue from that depth with the person already unconscious.

I am curious on this point. I see the diving community tends to use unconcious as a blanket term to mean not breathing and no heartbeat. This is not what unconcious is. Not breathing and no heartbeat is unconcious with no heartbeat and not breathing. Unconcious people can/and more often do have heartbeat and are breathing.

So I would have two questions, first is the person just unconcious? If so then their ability to offgas isn't effected since offgassing isn't a manual process but does reguire blood flow and respiration to happen effectively.

Secondly is the person not breathing and no heartbeat? If so then their might be a problem with off gassing. I would inflate the bc and take the person as close to the surface as possible then while I am doing my stop I would let the person go to the surface and the boat handle them. There is no reason in this case to make myself a possible second person needing assistance (this is if I was boat diving and there were people on the boat).

 

[Walter]

Excellent points. Skip the safety stop. Make your deco stops. Ascend at 60 fpm in emergencies.

One additional thing that should be mentioned. Before starting your ascent, look into the victim's mask. If you see water in the mask, remove the mask before beginning your ascent. Otherwise, expanding air will force the water into the victim's airway.