What do you do when donating to a panicked diver who initiates a buoyant ascent?

[Duke Dive Medicine]

I’m not familiar with the finger into the glottic opening technique to open an airway. Fingers wouldn’t be very effective in getting to the vocal cords. I’m not aware of any situation that stimulating a gag reflex would overcome a laryngospasm. Jamming fingers onto someone’s mouth also sounds like a good way to injure the oropharynx or your finger.

I’m also not sure if laryngospasm can crate enough pressure in the lungs to cause barotrauma vs active breath holding.

I’m not saying your technique didn’t work, but I’m not sure if that was the cause of the ending of the laryngospasm either. My guess is that jamming fingers into someone’s mouth is more likely to cause harm than good. Perhaps @Duke Dive Medicine can offer some more insight.

Thanks for the add. It seems like @Angelo Farina somehow pulled off a good outcome, but a few things strike me about the interventions here. First, inserting digits into the mouth of a panicked individual is a good way to lose fingers and aggravate the panic. I concur with you that attempting to manually open a laryngospasm would not only be ineffective because the spasm occurs farther down in the airway than fingers can reach, it would also cause the individual to gag and compound the problem.

I do think that laryngospasm could result in air trapping and pulmonary barotrauma. The question is how to handle it. In a rescue situation like the OP described, there's no way to differentiate whether the individual is panic breath-holding or in a laryngospasm, and I don't know that it would matter. It would be reasonable to attempt to slow the ascent and offer a regulator, mindful that doing so would also put the rescuer at risk, especially if there's a decompression obligation (I'm reminded of a couple of fatal accidents I know of here). We used to train commercial divers to exert pressure on the chest to try to gently force air out on ascent, but that requires considerable forethought and presence of mind in the moment. Sometimes the best you can do is be ready to provide first aid and medical evacuation after the diver surfaces.

Also, not to belabor this point, but out-of-air accidents are much better prevented.

Best regards,
DDM

 

[NothingClever]

I’d give it a sincere effort to calm down the person but if he were intent on bolting, I wouldn’t hesitate to rip my reg out of the OOG diver’s mouth rather than get dragged to the surface.

I did my part selecting a configuration that makes it easy to donate, not giving in to panic when my long hose reg was pulled from my mouth, being ready to calm the person down and get them to the surface.

But once on my air and still deciding to shoot for the surface?

Sorry, I’m not going to get bent or swept up in someone else’s panic.

The other person’s just a crappy diver, not my wife or daughter.

 

[kinoons]

Thanks for the add. It seems like @Angelo Farina somehow pulled off a good outcome, but a few things strike me about the interventions here. First, inserting digits into the mouth of a panicked individual is a good way to lose fingers and aggravate the panic. I concur with you that attempting to manually open a laryngospasm would not only be ineffective because the spasm occurs farther down in the airway than fingers can reach, it would also cause the individual to gag and compound the problem.

I do think that laryngospasm could result in air trapping and pulmonary barotrauma. The question is how to handle it. In a rescue situation like the OP described, there's no way to differentiate whether the individual is panic breath-holding or in a laryngospasm, and I don't know that it would matter. It would be reasonable to attempt to slow the ascent and offer a regulator, mindful that doing so would also put the rescuer at risk, especially if there's a decompression obligation (I'm reminded of a couple of fatal accidents I know of here). We used to train commercial divers to exert pressure on the chest to try to gently force air out on ascent, but that requires considerable forethought and presence of mind in the moment. Sometimes the best you can do is be ready to provide first aid and medical evacuation after the diver surfaces.

Also, not to belabor this point, but out-of-air accidents are much better prevented.

Best regards,
DDM

Thanks for the added insight. I have a more than passing familiarity with the glottic and laryngeal opening, but I’m not an ENT. The physiology is designed to prevent anything but air going down the trachea, not to prevent air from getting out; I am unaware if laryngospasm acts as a bidirectional blockage vs a one way valve.

 

[johndiver999]

I’d give it a sincere effort to calm down the person but if he were intent on bolting, I wouldn’t hesitate to rip my reg out of the OOG diver’s mouth rather than get dragged to the surface.

I did my part selecting a configuration that makes it easy to donate, not giving in to panic when my long hose reg was pulled from my mouth, being ready to calm the person down and get them to the surface.

But once on my air and still deciding to shoot for the surface?

Sorry, I’m not going to get bent or swept up in someone else’s panic.

The other person’s just a crappy diver, not my wife or daughter.

Once a person looses air supply underwater, they are most likely going to panic, sooner or later, anyway. Once a diver panics, then they become irrational (sorta the definition). It is unrealistic to categorize a person as a "crappy diver" if/when they panic.

Loss of air supply can happen due to gear failure rather than diver error. I think it best to have a very simple set of responses mapped out in your head, because once the situation starts, things happen fast and there is little time or opportunity to do "judo" moves or other complicated responses that vary upon the identity of the victim. As I said, once they got you by the hose, you are pretty much committed.

If I had a lot of nitrogen built up and I was really worried about being bent, I MIGHT try to strip the victim at 30 feet or something, especially if I had redundant air supply that would be available if they took my octopus to the surface with them. The reality of the situation is that if you are healthy, keep the lung volume neutral and don't panic too much yourself, your lungs can most likely take a very rapid ascent.

 

[JoeTPhilly]

Furthermore, retention of CO2 in the blood (due to excessive effort or incorrect breathing patterns) could cause air hunger (I don't know if this is the correct name in English), and the diver could convince himself that he has problems with the regulator.

Hypercapnia. That is what I thought when I read the account too.

 

[Angelo Farina]

Thanks for the add. It seems like @Angelo Farina somehow pulled off a good outcome, but a few things strike me about the interventions here. First, inserting digits into the mouth of a panicked individual is a good way to lose fingers and aggravate the panic. I concur with you that attempting to manually open a laryngospasm would not only be ineffective because the spasm occurs farther down in the airway than fingers can reach, it would also cause the individual to gag and compound the problem.

I do think that laryngospasm could result in air trapping and pulmonary barotrauma. The question is how to handle it. In a rescue situation like the OP described, there's no way to differentiate whether the individual is panic breath-holding or in a laryngospasm, and I don't know that it would matter. It would be reasonable to attempt to slow the ascent and offer a regulator, mindful that doing so would also put the rescuer at risk, especially if there's a decompression obligation (I'm reminded of a couple of fatal accidents I know of here). We used to train commercial divers to exert pressure on the chest to try to gently force air out on ascent, but that requires considerable forethought and presence of mind in the moment. Sometimes the best you can do is be ready to provide first aid and medical evacuation after the diver surfaces.

Also, not to belabor this point, but out-of-air accidents are much better prevented.

Best regards,
DDM

When I saw that the student was not exhaling, I started tipping on his lips. He reacted opening the mouth, but still no bubbles.
There was not a lot of time, we were ascending rapidly. So I inserted two fingers in his mouth. As I touched the soft palate, he started bubbling.
I do not know the details of these reflexes, what matters is that his airways were closed, and they suddenly opened.
And yes, he also chewed my fingers, they were scratched and bleeding.
My wife had a somewhat similar case in the pool. One of her student passed out during a test of static apnea.
She dived, retrieved the student, pulled him out of water with the help of her assistant instructor and started the procedure for artificial ventilation. The first step is ensuring that airways are pervious. But the student had his jaws strongly clamped. So she tried to force the mouth open inserting her fingers. As she touched the inner of the mouth the jaws clamped again, chewing her fingers. She reacted violently with a big slap on his face with her other hand. This was very effective, the student opened the mouth releasing her fingers and opened the airways with a big cough, after which he started breathing spontaneously and went back to consciousness after a few seconds.
So both of us did learn by first hand (literally) how dangerous is to insert fingers inside the mouth of a student...

 

[Duke Dive Medicine]

She reacted violently with a big slap on his face with her other hand. This was very effective, the student opened the mouth releasing her fingers and opened the airways with a big cough, after which he started breathing spontaneously and went back to consciousness after a few seconds.
So both of us did learn by first hand (literally) how dangerous is to insert fingers inside the mouth of a student...

And, not to bite your wife's fingers. Sheer resuscitative luck must run in both of your families

Best regards,
DDM

 

[Stoo]

If they're actually OOG, how is the power inflator working?

"Out of gas" rarely is as clearly defined as it sounds. A more accurate expression might be " So low on gas that my reg isn't working like I want, but once I get up a few feet, it might and I definitely have enough gas to get my BCD moving in the right direction" but it makes for a crappy acronym.

 

[Angelo Farina]

And, not to bite your wife's fingers. Sheer resuscitative luck must run in both of your families

Best regards,
DDM

Well, I also was victim of two epysodes of hypoxic syncope in the pool, and I was resuscitated by my instructor/trainer.
These episodes were common in the eighties, before proper methods for training free divers were developed.

 

[Diving Dubai]

I do think that laryngospasm could result in air trapping and pulmonary barotrauma.

I've had one myself, so I thought I'd give you some insight. Mine occurred at 25m. I was carrying a pony, and my initial action (there was no thought it was an automated response) was to switch to my pony since it felt like an OOG - this didn't solve the problem and looking at both my spg showed 50% and 100% respectively. All the time I'm trying to breath and getting nothing.

I suppose all this took place over 10 perhaps 15secs. Instinctively I headed for the surface - I didn't think to inflate, I just kicked. We were in the Red sea so 50m+ Vis. I distinctly remember the speed my brain was working at, it was like reading 4 column of text on a page simultaneously. The surface seemed so far away and seemed to take forever. My log showed I covered 12m in around 30secs. At 10m the laryngospasm cleared and my exhale was so violent it caused a mask flood

My wife (my buddy) just saw me take off in her peripheral vision, initially thought maybe I'd seen something and followed me. when she reached me I was finishing a mask clear. she asked if I was okay, my response was yes and we continued the dive - albeit at 12-15m I was conscious to not surface quickly incase I had come up too fast. I gingerly swapped regs back and forth but had no issue. The reg in question once we got back was thoroughly inspected by a very trusted individual who was looking for a cause, but no fault found. We presumed that somehow I inhaled a bit of water which trigger the event. At this time I was approaching 500 incident free dives, and I've logged 700 dives since with no repeat

Had someone tried to intervene and restrain me or try to force another reg in I would have hit then, since my body was in survival mode and acting instinctively