Woman dies during scuba dive off Wilmington

[Scubamedicjoe]

I am not condoning the EMT or empty oxygen or dead AED what I am trying to do is Improve the system , yes we Know cape fear had oxygen and yes we know CPR was done. well you do need little More regulation for dive operators .

 

[Wookie]

These are the guys doing boat inspections and it makes me wonder if they equallt adept at that. As far as EMT, every person on the boat performed CPR after the incedent. The last thing we need is more regulation and more govornment mandates. We have the Coast Guard and look how they performed.

Actually, if they were the guys at the local CG station, they certainly aren't the guys doing safety inspections, they are the guys doing random boardings and pulling drunks off of sandbars. Inspections branch is a very highly specialized part of the coast guard, and once qualified as an inspector, you're probably an inspector for most of the rest of your career. Most inspectors are officers, either commissioned or warrent, or very senior firsts and chiefs. Most of the guys running a 41 or a 47 are 18 years old, fresh out of boot camp, handed a Glock and told how important they are to national security. Medical professionals they ain't.

The only reason to have an EMT on a dive boat is to administer IV fluids, which is important in 1 out of 100 cases. Having a EMT can actually be a detriment, because you can't hand off the injured diver to the CG vessel/helo without handing off the EMT if the CG doesn't have one. You can never lower the level of medical care a victim is receiving. If the CG vessel/helo has no equivalent medical person than is on the boat, then the boat operator must give up the EMT. If the EMT is a part of the required crew, the vessel will be operating in an under manned condition, leaving the rest of the passengers at risk.

In an emergency, the Coast Guard is nothing more than a fancy transportation service, called to transport your injured diver faster than the dive boat can. If you think that the CG is a fancy flying ambulance or ambulance on a boat, you're sadly mistaken. For a CG boat to have any medical equipment on a 41 or a 47 shocks the crap out of me, and I'm not talking AED shocking.

On a commercial dive boat, an EPIRB is required, sufficient rafts that autoinflate are required, I don't know if O2 is required but it is damn sure present on every boat I've been on or read about.

It doesn't seem unreasonable to require an AED as well. If buying and maintaining an AED is going to put a diveop under, that's OK with me.

You are right about the EPIRB for vessels carrying more than 6 passengers for hire. Uninspected passenger vessels are required to have a lifejacket for everyone onboard with a light, flares, and if the boat is over 26 feet long, a ring buoy. No EPIRB, no life raft, no AED, no O2, no sat phone, no EMT. There are many commercial dive boats that fall in the "Lifejacket and flares" category.

Edit - PS. Diving is a dangerous sport, and medical help may be hours or days away from the dive site. You really do take your life in your hands when going on a dive excursion. To berate a dive operator for only carrying the required equipment or the Coast Guard for not showing up immediately just isn't fair. I have clients who would never show up on this boat without their own O2, ATLS kit, and EMT, even though we have our own. These are the folks who take responsibility for their own medical safety. It is not reasonable to expect the dive operator to exceed requirements, although it is nice when you find one who does.

 

[jeffloughridge]

Frank,

Here's an opportunity for me to learn something...

What is the criteria that separates an inspected from an uninspected passenger vessel?

I pretty much thought any commercial vessel would require an inspection. Every dive boat I've been on has started their safety breifing with "This is a Coast Guard Inspected vessel..."

I completely agree with being self sufficient and carrying your own emergency equipment to a degree, particularly on a live aboard. Same reason most give for owning their own wetsuit, BC, or whatever...you can control the condition and readiness.

 

[northen diver]

Actually, if they were the guys at the local CG station, they certainly aren't the guys doing safety inspections, they are the guys doing random boardings and pulling drunks off of sandbars. Inspections branch is a very highly specialized part of the coast guard, and once qualified as an inspector, you're probably an inspector for most of the rest of your career. Most inspectors are officers, either commissioned or warrent, or very senior firsts and chiefs. Most of the guys running a 41 or a 47 are 18 years old, fresh out of boot camp, handed a Glock and told how important they are to national security. Medical professionals they ain't.

The only reason to have an EMT on a dive boat is to administer IV fluids, which is important in 1 out of 100 cases. Having a EMT can actually be a detriment, because you can't hand off the injured diver to the CG vessel/helo without handing off the EMT if the CG doesn't have one. You can never lower the level of medical care a victim is receiving. If the CG vessel/helo has no equivalent medical person than is on the boat, then the boat operator must give up the EMT. If the EMT is a part of the required crew, the vessel will be operating in an under manned condition, leaving the rest of the passengers at risk.

In an emergency, the Coast Guard is nothing more than a fancy transportation service, called to transport your injured diver faster than the dive boat can. If you think that the CG is a fancy flying ambulance or ambulance on a boat, you're sadly mistaken. For a CG boat to have any medical equipment on a 41 or a 47 shocks the crap out of me, and I'm not talking AED shocking.



You are right about the EPIRB for vessels carrying more than 6 passengers for hire. Uninspected passenger vessels are required to have a lifejacket for everyone onboard with a light, flares, and if the boat is over 26 feet long, a ring buoy. No EPIRB, no life raft, no AED, no O2, no sat phone, no EMT. There are many commercial dive boats that fall in the "Lifejacket and flares" category.

Edit - PS. Diving is a dangerous sport, and medical help may be hours or days away from the dive site. You really do take your life in your hands when going on a dive excursion. To berate a dive operator for only carrying the required equipment or the Coast Guard for not showing up immediately just isn't fair. I have clients who would never show up on this boat without their own O2, ATLS kit, and EMT, even though we have our own. These are the folks who take responsibility for their own medical safety. It is not reasonable to expect the dive operator to exceed requirements, although it is nice when you find one who does.

EMT's are not allowed to start IV's. In many counties, the protocol is that they cant even intubate (even though they are trained in a NREMT course) Paramedics on the other hand can do so much more than a EMT but the training is so much more expensive and more intensive. Keep in mind that the NREMT recertifications are every two years also, which takes either a refresher course (three days) or quit a few CEU's.

The "flying ambulances" are called Life flights which carries at least a paramedic or in many cases an RN with ALS on board. The USCG SAR helo's are BLS responders in most cases with O2 and an AED. No ALS are on board.

 

[Wookie]

Jeff, Here is a place to start reading about uninspected passenger vessels. Basically, passenger vessels come in 3 types, uninspected, meaning vessels carrying 6 or fewer passengers (12 or fewer of over 100 gross registered tons), Small, meaning inspected, under 100 gross registered tons, carrying fewer than 49 overnight passengers and fewer than 149 passengers ever, or Large, being inspected, over 100 tons, carrying over 149 passengers, more than 49 overnight. Each level carries more requirements for operation. The Spree is a small passenger vessel. We are inspected by the Coast Guard, we have been tested to ensure we will remain upright under any sea conditions with a full load of passengers with one compartment flooded, our bunks are a certain size, we have seating and rail space for a certain number, etc. etc. Large passenger vessels have more fire fighting requirements, have rated fire walls between cabins, a larger number of required heads, etc. Uninspected means possibly as little as lifejackets and flares. And you won't HAVE to undergo a courtesy inspection. Why anyone would pass up the nifty sticker, Ai don't know, unless you were hiding something. I have no idea what kind of vessel Loanwolf's wife was on, I am only addressing this because most folks have this belief in the operator, that the operator will always do what the client thinks is right, and that the Coast Guard will make sure that the operator is doing what the customer thinks is right. The reality is that the Coast Guard has no special requirements for dive boats versus ferry boats versus crew boats operating in the Gulf versus a dinner cruise boat. The customer's expectations are most often not met, because their expectation is based on an assumption, and the assumption has no basis in fact. Usually, no harm, no foul, everything goes right and all is well. When bad stuff happens, and you expect an ambulance with a paramedic to show up at the dive site, or, better yet, a fully equipped Emergency room staff with all of the bells and whistles flying in in their chopper, or the dive boat captain to whip out his PADI deceased diver resurrection card, you will be disappointed.

Loanwolf, I am not being flip at your expense. I am deeply sorry for your loss. I just hate to see an operator or the Coast Guard held accountable on open forum for something that they have no control over.

Edit PS. A inspected vessel is required to start their briefing with "this is an inspected vessel...". An uninspected vessel is not required to give a briefing.

 

[Lone Wolf]

Jeff, Here is a place to start reading about uninspected passenger vessels. Basically, passenger vessels come in 3 types, uninspected, meaning vessels carrying 6 or fewer passengers (12 or fewer of over 100 gross registered tons), Small, meaning inspected, under 100 gross registered tons, carrying fewer than 49 overnight passengers and fewer than 149 passengers ever, or Large, being inspected, over 100 tons, carrying over 149 passengers, more than 49 overnight. Each level carries more requirements for operation. The Spree is a small passenger vessel. We are inspected by the Coast Guard, we have been tested to ensure we will remain upright under any sea conditions with a full load of passengers with one compartment flooded, our bunks are a certain size, we have seating and rail space for a certain number, etc. etc. Large passenger vessels have more fire fighting requirements, have rated fire walls between cabins, a larger number of required heads, etc. Uninspected means possibly as little as lifejackets and flares. And you won't HAVE to undergo a courtesy inspection. Why anyone would pass up the nifty sticker, Ai don't know, unless you were hiding something. I have no idea what kind of vessel Loanwolf's wife was on, I am only addressing this because most folks have this belief in the operator, that the operator will always do what the client thinks is right, and that the Coast Guard will make sure that the operator is doing what the customer thinks is right. The reality is that the Coast Guard has no special requirements for dive boats versus ferry boats versus crew boats operating in the Gulf versus a dinner cruise boat. The customer's expectations are most often not met, because their expectation is based on an assumption, and the assumption has no basis in fact. Usually, no harm, no foul, everything goes right and all is well. When bad stuff happens, and you expect an ambulance with a paramedic to show up at the dive site, or, better yet, a fully equipped Emergency room staff with all of the bells and whistles flying in in their chopper, or the dive boat captain to whip out his PADI deceased diver resurrection card, you will be disappointed.

Loanwolf, I am not being flip at your expense. I am deeply sorry for your loss. I just hate to see an operator or the Coast Guard held accountable on open forum for something that they have no control over.

Edit PS. A inspected vessel is required to start their briefing with "this is an inspected vessel...". An uninspected vessel is not required to give a briefing.

I did not hold the operator responsible, they acted in a professional manner. They had proper equipment and knew how to use it. However, the coast guard has as a part of it's mission statement it is a rescue organization!! When they show up and take over life saving duties, and their equipment is nonfunctional due to their negligence, that is their responsibility. To imply otherwise is a mistake. I did not expect an emergency room, just competent, trained people!! This expectation should be reasonable!! I do not blame them for my wife's death, I hold them responsible for their poor performance. I worked on a mountain rescue team in Colorado, if any of these things had happened at any time on any accident scene we would have been fired. So I know what acceptable standards should be. Even if the person you are working on is already dead, you show up with your equipment properly prepared, and properly trained in it's use!! Anything else is unacceptable!! And, yes they do have contol over the maintenance of their equipment, and the training of their personel.

 

[Scubamedicjoe]

EMT's are not allowed to start IV's. In many counties, the protocol is that they cant even intubate (even though they are trained in a NREMT course) Paramedics on the other hand can do so much more than a EMT but the training is so much more expensive and more intensive. Keep in mind that the NREMT recertifications are every two years also, which takes either a refresher course (three days) or quit a few CEU's.

The "flying ambulances" are called Life flights which carries at least a paramedic or in many cases an RN with ALS on board. The USCG SAR helo's are BLS responders in most cases with O2 and an AED. No ALS are on board.

Sorry to bust your bubble but yes emts are allowed to intubate along with administering many drugs state of NC has some of the most aggressive EMT regulations in the US ,
the follow link show what can be done under NC law , actually the Iv is less important in most cases as a secure and complete airway ,
http://www.ncems.org/pdf/NCCEPStandardsSkillsImplementation2009.pdf



I have great reservation as why the EMT had to be recruited other than was told there primary was out of place and had no EMT personally why didn't they contact local ems who would sent a Paramedic, with his equipment.
hind site we cannot change but for future responses lord forbid we can . and only improve on I hope. we can just learn not hear to argue about the emt personally the boat did what they was trained to do and had working equipment.

 

[Scubamedicjoe]

I think what Lone wolf stated to be a very true statement , is was poor to show up for lack better words ill prepaired.

 

[northen diver]

Sorry to bust your bubble but yes emts are allowed to intubate along with administering many drugs state of NC has some of the most aggressive EMT regulations in the US ,
the follow link show what can be done under NC law , actually the Iv is less important in most cases as a secure and complete airway ,
http://www.ncems.org/pdf/NCCEPStandardsSkillsImplementation2009.pdf

Under the NREMT, the EMT-B are not allowed to start or maintain a line. As I said earlier, under "certain counties" EMT-B's are not allowed to intubate (even though they are trained to do so) Yes, they can administer certain drugs, but not through a line. The USCG EMT-B's are NREMT's, not state certified.

 

[Wookie]

However, the coast guard has as a part of it's mission statement it is a rescue organization!! When they show up and take over life saving duties, and their equipment is nonfunctional due to their negligence, that is their responsibility.

You are absolutely correct, If the coast guard took over live saving duties with non-functioning equipment, that is inexcusable. You have a reasonable expectation that if they took over from the crew, they would have the tools in place to effect the takeover. My last incident on the boat, which ended up being a fatality, the Coast Guard took my AED, and O2 with them, as they were not equipped themselves.