Rescuing an unconscious diver underwater.

[laurin]

Lynn mentioned some of it--get yourself negative on top of the diver. Make sure the diver's dry suit vent is fully open. I like to lock my elbows on the two posts of the manifold for control. Start getting the diver buoyant with the inflator hose--after that you are looking primarily to vent to slow the ascent.

It is easy for the diver to go too vertical and even flip backwards. If you start moving the diver forward as you begin the ascent it helps.

All good points. Also, in addition to staying on top of the diver it helps a lot to keep the diver "lower" relative to your body - so that your right hand (the one that goes over the victim's shoulder and keeps the airway open) is reaching almost straight down, rather than forward and down. Your left hand will be reaching slightly back and down. This helps maneuvering a lot, as the tanks and wing won't be blocking your arms. Also, your thighs will be resting on the tanks, so you can quite easily push the victim's legs down with a couple of kicks if the feet get buoyant.

During the last couple of meters of the ascent you can completely fill the victim's wing and flip him over so he'll be facing up. It's not really difficult, easier to demonstrate than to explain...

This is a very efficient technique, during cave 2 we did unconscious diver tows for a couple of hundred meters inside a cave with lots of ups and downs without much difficulty...

//LN

 

[muddiver]

Dumping the unresponsive diver's weights at depth is going to make it difficult or even impossible to control their ascent, once you get them shallow. Although, if someone is not breathing through the entire ascent, gas embolism is likely, it is at least possible that during a controlled ascent, the gas can slowly expand and exit their airway. If you have to let go of them because they have become unmanageably buoyant, embolism is all but certain.

The one exception might be if the victim is so massively overweighted that you can't get them buoyant any other way. This was the case with a body recovery here in Puget Sound last year.

TSandM

Could you explain the reasoning behind an unconcious diver embolizing on ascent?

It would seems to me that if a person is unconcious/non-responsive that their airway would be relaxed allowing any gas build up to escape freely. Drownding is due to the eppoglottis (sp?) spasming shut from water contact, not from the action of breathing, or lack there of.

 

[TSandM]

Well, there are several mechanisms that might result in embolism. One is laryngospasm, which is not unlikely if somebody has aspirated water. Another is blockage of the posterior pharynx by the tongue. Another is obstruction of the airways with aspirated water. Remember that all you need for embolism is that the gas in the lungs is expanding faster than it can escape, not that it has to be blocked altogether.

 

[mudhole]

Huh?

Remember, not all people dive in the same configuration and, in fact, some gear (dry suits in particular) pretty much require people to remain horizontal while trying to ascend.

Peter. . . you've hit the nail on the head, different configurations require different responses. My experience was with an unconscious girl, with no air in her vest and a light wetsuit, I had some air in my jacket. . . when we reached the surface, I dumped my gear, left floating til later, and dumped her gear, for her partner to recover. I climbed onto my pontoon boat, while holding her arm. Both of us were clear of gear, and I did a "lifeguard bounce" which wouldn't work with her tank and BC on. And pulled her onto the deck, opening her airway. . . immediate problem solved.

Her dive partner had called for help, a group of divers swam out to help, and like in many accident circumstances, bystanders wanted to help but didn't know what to do.
they voted her dead. She was blue, and making "funny noises" .

Lesson learned, I knew CPR, I had previously had life guard training, and was looking at the variables to fit my response to what was happening that day and that problem. The girl's next dive was 6 months later, at midnight New Years eve. I agreed to dive with her, and "accidentally" kicked her weight belt under her dive bag. I entered the water first, she jumped into the water, splashed on the surface, we went straight to the ladder and out immediately. She was happy starting a new year, as a diver.

 

[Doc Harry]

I found that, as I neared the surface, it becomes too much to try to control both the victim's BC and my own BC. You've got one hand on the victims chin to maintain an open airway, and one hand on the victim's inflator. You need a third hand on your own inflator (and maybe a fourth hand on your dry suit valve). I could see myself getting into an uncontrolled bouyant ascent if I couldn't manage both our BCs effectively on ascent.

I prefer to dump all of the air out of my BC and use only the victim's BC for the ascent.

 

[hudson]

I also find it very difficult to manage both BCs and potentially both drysuits - however I will use my own BC, not the victim's. It's much easier for me to tell how much air I have in my own wing, whether I'm dumping successfully etc. I don't see much point in trying to manipulate a BC I'm not familiar with, not to mention it's a lot more difficult to manage the situation if the victim gets too buoyant whereas it's trivial to recover if I get too buoyant.

 

[Bogie]

In Rescue Diving Class I learned the number one rule is to keep yourself safe. You are not any help to anyone if your in trouble. The deeper the victim is, the more dangerous the assent. You must keep your own assent safe. I was told if the diver is unconscious all their muscles are relaxed and therefore excess air will release naturally. If they have vomited it could plug the airway but the expanding air on assent would probably clear it. Ideally the head should be back but even if it is forward air should clear naturally. You can check this by turning your neck forward as far as possible even with your chin on your chest and notice you can still breathe.

Getting them to the surface with you safe is number one. If on ascent they start shooting to the surface and you are putting your own self ascent at risk you let them go.

If the goal is to keep yourself safe, I would empty their BC and use my own for bouyancy because it is easier to control. If for any reason the ascent gets out of control, let them go, take care of yourself, and make sure you have a safe ascent. If they shoot up to the surface, you make sure to take care of yourself and surface safely. Inflate their BC, and go through the rescue steps.

One thing that I don't understand is that you don't check for pulse. I know you cannot do chest compressions in the water but to take all the extra time to provide a breath every 5 seconds could be a total waste and could waste valuable time getting them back on the boat or to shore. Breaths don't matter if the blood does not carry the oxygen to the vital organs (brain). It would seem to me that you would check for pulse, if no pulse get them out of the water asap to conduct full CPR and don't waste time and energy getting useless breaths in them that don't go anywhere.

This is just an opinion I have and I could be totally wrong on this. I would like to get input on this from a medical professional. Any comments appreciated.

 

[peterbj7]

Interesting discussion. It's important to remember that an unconscious diver on the bottom is either dead or about to be. Nothing that you can do can make that situation worse. Although in principle an unconscious person may still be breathing, in practice underwater a conscious effort is required to keep the regulator in the mouth and sealed, so unless the diver is wearing a full face mask we can assume that the mouth is full of water and breathing has ceased.

That said, you get the diver to the surface by whatever means you can that don't endanger yourself. If it is possible to give the diver buoyancy I'd do that, so that in the event of separation the diver will continue to the surface. If it's possible to control the victim's ascent rate and surface with him (the generic "him") then do it, but don't get hung up on it. In almost all practical circumstances air will vent automatically from the lungs of an unconscious diver, and I think you have to assume that to be the case.

So if I can I add buoyancy to victim and myself, then on the way up control mine and if possible also control the victim's. If not possible, I just let him go. I don't see an alternative.

I've been involved in two rescues/recoveries, both many years ago. In one case the BCD had been ripped on a very rough wall during an uncontrolled descent in very deep water. All I could do was release the weights and ancillary gear (camera housing) and watch to see that buoyancy took over. She appeared dead at the bottom and she was confirmed to be dead at the surface. I left the weights on the bottom and brought the camera up on my own controlled ascent.

In the other case there didn't appear to be any equipment issues (although in fact there were, but I couldn't know that then). The diver was still descending (deep water) and I managed to catch him, though I went down a fair bit myself until I was able to correct. Diver's reg was out of his mouth. I pressed the purge button on the 2nd stage and nothing came out, so I assumed (wrongly) the tank was empty and didn't try inflating the BC. It already had some air in it - the descent hadn't been precipitous - so I simply took a very firm grip on the harness with one hand and started ascending with my own buoyancy and effort. I didn't do a very good job of it and left it too late to vent the victim's BC. By then I couldn't reach and the victim rose uncontrollably. I followed as fast as I could, but luckily someone had seen him surface (we were in a freshwater quarry) and the situation was under control well before I surfaced. That guy survived, with no apparent long-term injuries. I think he discontinued diving though. Turned out something went wrong inside his first stage and blocked air to the primary second stage. It appeared when his gear was tested that both his octo and his BC feed would have worked, had either of us tried them.

Both these victims were clearly unconscious. I've never tried to rescue someone convulsing, but I think probably I'd try to surface them as fast as possible under control. I realise the risk of the airway being blocked, but part of convulsing is involuntary breathing in, and once they have water in their mouth they're going to drown quickly. I reckon a chance of an embolism is better than the certainty of drowning.

 

[boulderjohn]

Hey John,

Do you have a copy of AG's report on he rescue? My copy is on my other laptop that has a damaged screen from an unfortunate accident with my son's airsoft gun.

Sorry for the delay. I was out of town diving in New Mexico. Coming back last night with a van full of industrial helium and O2 bottles, doubles, etc., we hit a rock the size of a beach ball on the Colorado side of Raton Pass. I am currently in a motel room in Trinidad trying to figure out what to do with a disabled van.

My computer is in worse shape than yours at the moment. After months of continued problems, Dell sent me a new hard drive, which I installed just before leaving. I have only the bare minimum stuf on it right now. Anything I had as a link is gone. Anything I had that was downloaded is back at my home on an external hard drive awaiting my return.

 

[halocline]

I don't think I would want to get above the victim, I'd want to stay behind, in control of his/her inflation and tank, in case the victim regains consciousness and starts to panic. I was trained to evaluate the situation (like is there air for inflation in the victim's tank, how negative is the victim) and first attempt to use the victim's BC My experience in practicing this (I've never actually had to drag an unconscious diver off the bottom, thank God) is that unless the victim is really overweighted, it takes very little air in the BC to get someone off the bottom. If the victim is obviously overweighted, it's a simple matter to drop a few pounds. IMO there's absolutely nothing wrong with swimming/kicking to get going towards the surface; I'm not sure why Peter seemed to object to that.

I seemed to have the best sense of control putting a puff of air in the victim's BC, staying behind, keeping my left arm on his/her inflator, and swimming. I'd very cautious about adding air to my own BC; if I had to do that, I would really want to vent it BEFORE getting too much momentum. The problem is, if you're behind the victim to establish and maintain good physical control without putting yourself at risk from possible panic, your left arm is busy on his/her inflator and you have to let that go to vent your own BC.

I would not make the victim positive at depth, IMO it's asking for a runaway ascent. I guess given the fact (as Lynn pointed out) that an unconscious diver at depth has VERY poor chances, a runaway ascent is not that critical a problem. I just think that once you get a victim off the bottom and moving to the surface, it's pretty unlikely that he/she will sink back down unless there's a serious overweighting problem, which you can take care of on the bottom.