Rescuing unconscious diver question

[kidspot]

Thanks for the survival rates NetDoc - My AED training was led by our county head paramedic - he was telling us that he had only seen 1 patient resucitated by manual compression in his career that survived, but they had 3 the first month they started putting AED's into patrol cars. Once he saw how effective the AED's were he headed up a campaign to put them in every patrol car, now he's putting them in all the local Gymn's, auditoriums and churches (he and several other paramedics are actually paying for many of these) My church was recently a recipient of one of these, for which we are very grateful. IIR he said they saw 40 revived patients during the first year after all the Police Patrol vehicles were equipped with AED's.

 

[H2Andy]

ok, but still... you guys are talking about dry land cardiac arrests

when you have a victim whose heart has stopped beating due to drowning,
i think the AEDs are not going to make much of a difference

 

[The Chairman]

Andy,

it appears that quite a few "drowning victims" still have air in their tanks. It could very well be a stress induced heart attack that did them in. As I said in earlier posts: YOU CAN'T HURT A DEAD PERSON. So try the AED if you have it. You can't kill them twice.

 

[Cacia]

I think you are right. I don't think they jump start a flat line (asystole) very well. ..but since it wouldn't fire, no loss. heck even if it did fire..no loss.
curious, andy, fla cave divers...do you all have o2 access at the dive sites?

 

[The Chairman]

The ambulance can get to most of the cave sites PDQ! I saw a heart attack at Ginnie a couple of years ago, and was surprised at how responsive they were.

Most of us carry Oxygen. I always have at least one of my bottles and regs ready. I own 8 O2 bottles and 3 sets of regs since I teach it.

 

[kidspot]

I'd guess there are very few statistics on this issue... but at their current cost it seems like a viable addition to a first-aid kit for anyone that deals regularly with groups of people. I had considered getting one to put in my truck for where I work as a night guard (hotel) ... fortunately the hotel beat me to it and put one in the office finally.

 

[kidspot]

The ambulance can get to most of the cave sites PDQ! I saw a heart attack at Ginnie a couple of years ago, and was surprised at how responsive they were...

Of course on-site is even quicker what were the ratios of recovery? -10% for every minute delay in heart attack patients... with best success in the first 4 minutes...

We have a good team of paramedics in my area, but only 2 units to cover a 15 mile stretch of hotels etc.. if one is transporting somone the other one is then 15 minutes away from where they may be needed. That is probably why it can take awhile for a response at times. Just stretched too thin at times (but not often enough to warrant another team apparently) I've had them respond in as short a time as 7 minutes and as long as 30. To locations within 1 mile of the nearest base... which means only a 30% chance of survival at best.

I'm not commenting on your area (sounds like they may be able to respond more quickly) just observing a person's chances if no help is available... on a boat around here 15 minutes would most likely be the quickest time possible getting back to port to meet a waiting team of paramedics.

I do believe we have now hijacked our own discussions

 

[TSandM]

You guys realize that, as we are talking about all of this, part of the reason we can differ in our opinions is that there are NO GOOD DATA. There simply aren't enough people who arrest underwater -- where somebody else sees it and can help -- to generate a database that will help us decide what the best course of action is. All the stuff we're taught is somebody trying to think the problem through ON LAND and come up with a good solution.

On land, the best intervention is shock. That's known. On land, the most common reason for a cardiac arrest is coronary artery disease, and many times, the rhythm is Vtach or Vfib, which are amenable to shock. Getting the person out of the lethal rhythm is the BEST intervention. CPR is critical until the shock is available, and between shocks, but shock is best.

In the water, it's more likely that the arrest is respiratory . . . and primary respiratory arrest (eg. in this case, drowning) tends to lead to asystole, or no heart rhythm. You can't shock somebody out of asystole. Rarely, if you correct the condition that created the asystole and do enough effective CPR, you might get a shockable rhythm. Generally, if asystole has persisted more than a short time, we call the code.

Heart disease is still the number one killer in the US, and a large number of people arrest out of the hospital. We collect data on these arrests, and the interventions, and despite doing that for decades, the American Heart Association KEEPS changing the ACLS protocols, as we discover the things we were taught to do for cardiac arrest patients really don't work very well. When you consider the small number of arrested divers in comparison, it is easy to see that nobody really knows what we should do.

If you don't have medical training, do what your Rescue class taught you. If you do have medical training, apply what you know and your common sense to the situation, and do what you think is reasonable and appropriate. Don't create a second victim. Don't take extreme risks in the setting of an unlikely good outcome.

 

[H2Andy]

As I said in earlier posts: YOU CAN'T HURT A DEAD PERSON. So try the AED if you have it. You can't kill them twice.

no doubt.. .. but that's not my point

my point is that given the circumstances of the heart stopping due to drowning, the actual usefulness of an AED is going to be remarkably low

by the time you get the person in the boat, their heart is going to be stopped.

you hook up the AED and it doesn't detect the fillibration thing (sp?) thus
it doesn't shock the victim.

you have thus accomplished nothing. but by all means, if it's there, use it.
you never know.

In the water, it's more likely that the arrest is respiratory . . . and primary respiratory arrest (eg. in this case, drowning) tends to lead to asystole, or no heart rhythm. You can't shock somebody out of asystole.

said much better than i ever could

 

[ArcticDiver]

It has been alluded to a couple times. But the most important thing in any rescue attempt is to not unreasonably risk your own health and life. Many get the adreniline fueled rescue at any cost attitude. Resist At All Costs! It helps no one to create a second victim. Or, worse compromise the original victims chances, if any, because resources have to be diluted over two, or more, victims.

To help put it into perspective: Next time someone claims high survival rates ask them where the measurement was taken. Was the measurement taken when the patient was delivered to the ER? Or, was it taken when the patient was discharged, intact, from the hospital? Bet you find that it is rare for a person to ever make it to discharge.

My take: Do everything feasible without undue risk to the rescuer to recover the victim and give them any chance at survival they may have. Exactly what to do and how to do it will have to be ad hoc because we really don't know enough to do it any other way.

Sometime go with your buddy and a third safety observer to your favorite dive place. Practice rescues from different depths and circumstances while keeping all actions within accepted, safe parameters. Keep track of just how long it takes. Match that time against the time the brain can survive without oxygen. Once you do that your perspective on the efficacy of rescue will change.