Using resuscitation mask in water

[Thalassamania]

I happen to prefer that style of snorkel.

 

[freediver]

Omitting any need for chest compressions which would certainly change the dynamic here, a victim of ascent blackout or brief submersion drowning would benefit from immediate in-water breaths. The inherent problem is buoyancy or lack thereof. As a lifeguard, this is remedied with the use of a rescue tube (don't confuse with a rescue can) which holds the victim's face above water and allows for the leverage of delivering breaths. Is it challenging? Yes, but as is the case with anything else effective diligent practice will lead to acquisition of, in my opinion, a very worthwhile skill.
There are submersible manikins available but they are generally for recovery and usually do not have ventilation capabilities. For practice in my lifeguard and freedive courses, I have devoted a CPR Pal manikin for this use. I place him on a thin air mattress and practice in-water ventilations. By the way, I use two hands and also use a rescue tube for support. There is very little research on the efficacy of in-water res. but what I have seen is enough to make me hold on to my current practice.

 

[fisherdvm]

Here's a study in the new england journal of medicine, Jan 2008. They noted that if you get a patient in cardiac arrest to a defibrillator within 1 minute, their chance of survival is 34% (circulation restored in about 60%, but only 34% survived). If a patient with cardiac arrest received defibrillation greater than 2 minutes out from the event, the survival rate drops to 21 %.

Soooo, if you see witnessed an old guy in the water that likely had a cardiac arrest, and there is an aed on the boat.... Swim him to shore ASAP, and forget the rescue breath....

In the same way, a large study done in Japan noted that chest compression alone is better than CPR with rescue breath.

I think it is time for us to forget the in water rescue breaths (except for immediate witnessed drowning...) and just aim for defibrillation.

More emphasis in rescue class should be on making AED available at all dive sites, dive boats, and resorts.

 

[String]

I've not been to a single inland dive site or seen a single dive boat with an AED.
Its hard enough here to get leisure centres to buy one given the cost yet alone anyone else.

AEDs are very useful but very rare here.

 

[fisherdvm]

The cost of a used AED is between $500 to $1000. The cost of a new AED is between $1000-$2000.

AED's can be bought from Staples without a prescription.

You do not need to be trained in first aid, CPR or be certified to apply an AED.

An AED will not fire unless the patient needed the shock.

There is no good reason for a dive center not to have an AED if they can afford a DAN oxygen kit.

AED batteries last 3 to 5 years if unopened, and 1 to 3 year installed in the AED.

An AED's value in cardiac arrest GREATLY exceed any oxygen kit on the planet.

DAN needs to do more to teach AED, market AED's, and encourages AED use.

If one wants bad enough to have an AED, a used one can be purchased on Amazon.com or DOTMED for about $350 to $500.

 

[Thalassamania]

I am seeing a rather disturbing trend. As our diving population ages there is a need for better medical screening and cardiac testing, but rather than insisting on this the recreational agencies (note that AAUS requires a stress test after age 40) seem to be moving in the direction of simply installing more "emergency services" on dive boats, rather than bitting the bullet and taking positive steps to recommend and require more stringent medical screening of older divers, even those who are already certified.

While I understand the value of AEDs in heart attacks, I really wonder if dive boats are the place for them. Oxygen came aboard the dive boat in response to a need for "first aid" for diving accidents, not as a way to deal with heart conditions. Similarly CPR was taught as an adjunct to diving classes as a method for attempting to help a drowning victim, not as a way to assist an individual who was having a heart attack.

I have no problem with having a well trained and equipped first responder group. I just wonder if, in the long run, that is the best way to go. When there is an AED aboard every boat, and at every beach, and at every dive site, will that make any difference? Will that be more effective than more stringent medical standards?

 

[String]

£1000 is a lot of money for a dive centre or charter boat to shell out.

Given charter boats (or even inland sites) aren't required to provide any first aid or oxygen at all we're lucky that most do (even then they don't have to provide anyone trained in their use but again most do). I cant see them paying an extra £1000 out of the goodness of their hearts for AEDs.

Im also inclined to agree that medical screening would in the long term save more than AEDs everywhere (although obviously both together would help a lot).

 

[fisherdvm]

Im also inclined to agree that medical screening would in the long term save more than AEDs everywhere (although obviously both together would help a lot).

When you start requiring medical screening of divers, then you are regulating a sport. Where does it stop next? Bowling, ice skating, rock climbing?

Driving a car is dangerous to yourself, and others. Diving is dangerous to yourself, and not others. If we don't require medical screening of drivers, why would we need medical screening of divers?

I think society saves more money by letting older high risk divers dive. If they had an MI and cardiac arrest on a dive boat, the chance of saving them is almost nil. Therefore, society saves a bit of money by not prolonging their life in the ER, the intensive care unit, then cardiac rehab after bypass.

If the dive boat had an AED, their chance of surviving increases. I really think, the nice thing about an AED is you could potentially save a healthy young person who's heart has stopped from near drowning. Then the value of it is much higher. These accidental drowning, which I don't know how many can really be helped by AED's - where medical screening will not help you... might be where AED's would benefit the most.

Hopefully we will have an insight on this from someone familiar with drowning death and defibrillation.

 

[fisherdvm]

Statements on automatic external defibrillation use | International Life Saving Federation

This article suggests that we have very little information on the effectiveness of defibrillation on near drowning victims. But that we should consider using AED's. Apparently not too much data yet on the matter.

 

[Thalassamania]

I read this:

...

There is no clear evidence of the value of early of defibrillation following near drowning. Cost-benefit analysis for early defibrillation by lifeguard programs is absent. There will always be interesting discussion about the priority of early defibrillation by lifeguards in relation to other training and equipment needs of lifeguards and lifeguard programs.

Lifesavers and lifeguards have the unique challenge of providing rescue and resuscitation service in and around water. Drowning and near drowning are hypoxic events with significant consequences 6 7. The prevention of drowning deaths and near-drowning accidents must remain a principle function of lifesavers and lifeguards.

...

6. Lifesavers and Lifeguards may play a role in the delivery of AED if this is consistent with the support and service priorities of that community.
7. If lifesavers or lifeguards will be delivering AED, they must receive appropriate training in the use of AED and the associated issues related to outcomes, stress and grief.

as indicating that money would be better spent on physicals.