View Full Version : Question for Instructors
If you have just lifted an unconsous diver from 20 meters and you are 200 meters from the shore with no help, what would you do?
Tow with rescue breathing to the shore would be my first choice, but if the surface swell was to much (over the casualties face) then i would opt for Tow to the shore then rescue breathing and CPR.
i think you have to call it as it happens.
dive granny
21-09-06, 21:14
Tow with rescue breathing to the shore would be my first choice, but if the surface swell was to much (over the casualties face) then i would opt for Tow to the shore then rescue breathing and CPR.
i think you have to call it as it happens.
I agree with you. You go with how events are at the time. Adrenalin can make you do amazing things!!
dive granny
21-09-06, 21:31
I agree with you. You go with how events are at the time. Adrenalin can make you do amazing things!!
Just realised it says 'For instructors'. Sorry:p
I would pretty much follow the ScotSAC recommendations: a couple of rescue breaths upon surfacing, wave for help (I know you stated there was no assistance, but you never know who could be lurking in the bushes), start tow with rescue breaths every 10 sec or so. 200m is a long tow especially in adverse conditions but adrenalin would no doubt kick in. With regard to the option to give CPR in the water, as far as I know (and I'm willing to be contradicted here), it's not possible to give chest compressions while swimming (especially to a victim in full diving kit). Upon beaching, we are recommended to commence CPR and of course contact the emergency services. Medics may argue that CPR can lead to dysrhythmias if there is an existent cardiac output but trying to find a pulse in such circumstances would be difficult for a non-medically trained rescuer.
I've not voted as my response is not there: "Tow with rescue breathing to the shore, then contact Coastguard & commence CPR if appropriate"
Interesting topic for discussion, Ding. Do you have a particular reason for raising it? I have to say that I've not been in such a situation, so to hear feedback from a real event would be useful if others are willing to post their experiences.
I used to do quite a bit of lifesaving with a club. There was always the theory version of a rescue and how you would do it in practice. I think in this case the theory is to tow to shore while giving rescue breaths every 5 seconds and then land and carry out full procedure, however in practice, I would get a couple of rescue breaths in, then get the person ashore as quick as possible to go through procedure then.
. Medics may argue that CPR can lead to dysrhythmias if there is an existent cardiac output but trying to find a pulse in such circumstances would be difficult for a non-medically trained rescuer.
Due to the difficulties in finding a pulse (some horrific statistic that a large percentage of doctors failed to recognise a pulse in a live person or found one in a dead person!), most organisations now recommend looking for signs of circulation - blue tinges in lips, extremities etc. suggests no circulation. Pinching skin and seeing blood come back does.
The guy who taught my heartstart and O2 instructor course said what's the point of ventilating a divers lungs if his heart is not pumping, (lifting an unconsious diver) His brain has 4 mins!!! so RB (rescue breathing) is no good without CPR.
How long was the diver lying on the seabed before u found him say 30 secs
How long to take him to the surface say 1 min
How long to tow him ashore say 2 min
His brain lasts 4 mins without O2
Its going to be a race against time
This should be practiced on a regular basis....
Gas Guzzler
22-09-06, 10:20
A couple of quick breaths on surfacing, just in case the heart is still beating then get to shore as quickly as possible.
You can then start effective CPR and will be better able to treat shock. It's going to be at least an hour before before they get to hospital.
Just wait till the adrenallin kixcks in and see how quick you can get to shore!
I was just behind a biker who clipped the back end of a left turning bus on Bearsden Road.
Ever tried doing first aid on a busy dual carridge way at 5pm on a Friday night, even with you car parked for protection.:eek:
The guy who taught my heartstart and O2 instructor course said what's the point of ventilating a divers lungs if his heart is not pumping, (lifting an unconsious diver) His brain has 4 mins!!! so RB (rescue breathing) is no good without CPR.
How long was the diver lying on the seabed before u found him say 30 secs
How long to take him to the surface say 1 min
How long to tow him ashore say 2 min
His brain lasts 4 mins without O2
Its going to be a race against time
This should be practiced on a regular basis....
Ok, you didn't specify if the unconscious diver (a) was breathing or (b) had a pulse.
If a diver has a pulse and is breathing, then all you need to do is tow him in.
If a diver has a pulse but is not breathing, then rescue breathing can be used, and could potentially be effective.
If a diver has no pulse then rescue breathing is not going to be effective because any oxygen introduced to the body will not be pumped around the body.
Lizardland
22-09-06, 12:30
I don't imagine many divers would be capable of checking for a pulse on another diver in the water especially in Scottish conditions: cold hands, drysuit, hood, etc.
If they're breathing then they will have a pulse. If they aren't breathing then they may or may not. Either way the chances of giving CPR in the water are nil -- I'm sure I read somewhere that lifeguards who attempted it just ended up causing further injuries.
I wouldn't attempt to check for a pulse in the water, it's a waste of time. If there is no pulse then there is no point giving breaths, you might be better off just getting the diver to shore where proper CPR could be given a hell of a lot quicker. If there is a pulse then breaths might help. It's a judgement call that needs to be made, is it better to not give breaths and tow quick enabling CPR to start sooner or give breaths in the water but delay the start of CPR?
It may sound harsh, but it seems unlikely to me that any victim who has suffered from acute heart failure underwater could be successfully resuscitated unless very near the shore. As already stated, you only have a few minutes before irreversible brain damage occurs.
So it seems to me that the best bet is to give regular rescue breaths (RBs) on surfacing and while towing. That way, if there's a cardiac output (CO) then anoxia will be prevented; if there's no CO then the prognosis is v poor anyway and the mild delay from giving RBs would have little impact on the outcome. CPR should still be considered on land: removal from water reduces the hydrostatic pressure on the body which could exacerbate circulatory collapse. But CPR is only a means of crudely pumping some blood around the body: research has shown that it's unlikely to actually resolve any underlying cardiac problem itself. So it's essential to summon the paramedics immediately to see if they can establish a productive heart rhythm.
Just my thoughts ;)
bubblemaker
22-09-06, 16:14
hmmm, this is an interesting one.
If as in Ding's scenario, there is no help available then there is a very real risk that your casualty is going to end up with a very serious case of death.
Regardless of how you get them to the shore, how do you summon help?
Remove your kit - probably done on the beach after you land the casualty.
Try and be flexible enough to unzip your own suit, and remove it enough to get car keys out. Get to your car to get phone. Hope beyond all hope that at whatever dive site you're at you can get a signal. Phone 999 and ask for the Coastgurd, then go back and help your casualty, by which time they are probably dead.
With regards to being on the surface with them... I'd probably clear their airway, in case they are breathing, ditch their weight belt to make them lighter, and tow like buggery to the shore... when you get close to the shore ditch their BCD to make them easier to beach. But it does strike me that it is very likely all you are doing is recovering a body.
Given the small time scales involved in the worst case scenario, it seems worth pointing out the coastguards desire for us all to inform them where we are diving. If diving off a boat, then hail them on Channel 16, if shore diving phone them (there numbers can be found here https://mcanet.mcga.gov.uk/public/c4/seasmart/index.htm) that way in an emergency you have already given them your location when you are calm and collected, rather than pumped full of adrenaline, stressed, possibly suffering from shock, etc etc.. and as you are describing the incident to them, help can be on its way.
And lastly... never forget folks... diving is FUN!!!
ditch their weight belt to make them lighter, and tow like buggery to the shore... when you get close to the shore ditch their BCD to make them easier to beach. But it does strike me that it is very likely all you are doing is recovering a body.
wash your mouth out man... you always bring ther kit back.
have you any idea how much this gear will net you on ebay? :D
sorry... am im being flipent here? or are we allowed to have fun answering this question also?
answers on a postcard!
So it seems to me that the best bet is to give regular rescue breaths (RBs) on surfacing and while towing. That way, if there's a cardiac output (CO) then anoxia will be prevented; if there's no CO then the prognosis is v poor anyway and the mild delay from giving RBs would have little impact on the outcome.
i think charlie has a valid point!
I'd go with charlies answer which as he says is not on your list
tow with mouth to mouth then CPR on the surface
CPR can lead to dysrhythmias if there is an existent cardiac output but trying to find a pulse in such circumstances would be difficult for a non-medically trained rescuer. = if the person is unconsous (possiable dead) then always go for CPR since 2001 the world wide recomendation is not to check for a pulse just go straight to CPR it takes too long to find a pulse, you could be very cold making it harder to find, the person could be on certain med making there pupils delate. etc,.the quicker you give them mouth to mouth (pocket mask,nose etc,.) the better chance they have and less chance of brain damage.
Very good scenario as lots of divers do dive in pairs with no shore cover. As mentioned before CPR is useless in the water. Our first reaction would be to tow to shore as fast as you can, however, if you are knackered you could be useless to the casualty.
I don't think there is a best answer as it would depend on the conditions of the day, so is it best to RB while saving energy by letting the tide take you to shore? This might be OK with a consious diver, but time is crucial to an unconsious diver. Of course we could bring back snorkel cover :rolleyes:
diverrepair
23-09-06, 14:08
Of course we could bring back snorkel cover :rolleyes:
Or even everyone wearing a simple snorkel - even under the knife straps - so you can supply air whilst continuing to swim.
Ok, you didn't specify if the unconscious diver (a) was breathing or (b) had a pulse.
If a diver has a pulse and is breathing, then all you need to do is tow him in.
If a diver has a pulse but is not breathing, then rescue breathing can be used, and could potentially be effective.
If a diver has no pulse then rescue breathing is not going to be effective because any oxygen introduced to the body will not be pumped around the body.
I expected you to think unconsious on the bottom... not breathing...and pulse... well gloves, cold forget it.
But you are right I will be more specific next time (lawyers need all the facts)
Contact Bert Smith of SSAC, he does the heart start courses.
His number can be obtained from SSAC web site.
Heart attacks.
I know of on instance many years ago when a diver had a heart attack under water.
His life was successfully maintained until the rescue services arrived.
Unfortunately he died later due to heart problems.
The bottom line is that if you start either, then you do not stop until relieved or a medical person declares the person dead.
I'd go with charlies answer which as he says is not on your list
tow with mouth to mouth then CPR on the surface
CPR can lead to dysrhythmias if there is an existent cardiac output but trying to find a pulse in such circumstances would be difficult for a non-medically trained rescuer. = if the person is unconsous (possiable dead) then always go for CPR since 2001 the world wide recomendation is not to check for a pulse just go straight to CPR it takes too long to find a pulse, you could be very cold making it harder to find, the person could be on certain med making there pupils delate. etc,.the quicker you give them mouth to mouth (pocket mask,nose etc,.) the better chance they have and less chance of brain damage.
Yup. That's what I would do. This also reflects what St. Andrews are teaching currently ... I think.
A related point here is the need to use Little Annies poolside when rescue training.
IMHO
Was watching TV the other day and they were talking about teaching lifsaving at schools. The guy said that its 30 compressions to two ventilations we were taught 15 to 2. I'm a heart start instructer and nobody told me....
You would think when things are changed they would let u know:confused:
diverrepair
24-09-06, 19:07
Yeh, the general consensus changed about 5 months ago. The thought is that it takes about 14 compressions (minimum) before an effective cardiac output starts to shift blood. Plus there should be more than enough oxyhaemoglobin in situ to ensure cell survival for that period of time - so 30:2.
Still like 5:2 on a bag myself - but.
OK, anorak off.:o
Was watching TV the other day and they were talking about teaching lifsaving at schools. The guy said that its 30 compressions to two ventilations we were taught 15 to 2. I'm a heart start instructer and nobody told me....
You would think when things are changed they would let u know:confused:
it has chaned but SSAC,PADI BSAC etc,. have still to change i.e all the text etc,. so will take a bit of time to be on all the courses paper work etc,.
but 30-2 is what they want now
Here's the current BSAC recommendation;
In-Water Life Support
...Open the casualty's airway by applying gentle neck extension
If there is no spontaneous breathing on opening the airway in this way give rescue breaths for approximately 1 minute (10 Rescue Breaths) (See 1 Minute Rescue Breath Sequence Note below)
If no spontaneous breathing returns, tow casualty while giving rescue breathing at 2 breaths/ 15 seconds
When in standing depth, or at boat prior to landing, continue rescue breathing for 1 further minute (10 Rescue Breaths), then dekit and land as quickly as possible WITHOUT further rescue breathing...
Here's the current BSAC recommendation;
In-Water Life Support
...Open the casualty's airway by applying gentle neck extension
If there is no spontaneous breathing on opening the airway in this way give rescue breaths for approximately 1 minute (10 Rescue Breaths) (See 1 Minute Rescue Breath Sequence Note below)
If no spontaneous breathing returns, tow casualty while giving rescue breathing at 2 breaths/ 15 seconds
When in standing depth, or at boat prior to landing, continue rescue breathing for 1 further minute (10 Rescue Breaths), then dekit and land as quickly as possible WITHOUT further rescue breathing...
So BSAC and SSAC are in need of an update what is the position with PADI?
Think I'l contact SSAC and ask what the position is.
bubblemaker
25-09-06, 00:38
according to 'the book' as it were, SSAC's position is very similar t BSAC's in that they say give 10 cycles of RB on the surface then tow, and administer CPR/EAR when they are landed.
just to cheer you all up. when i did my first aid training... in a mass casualty situation... if there was no pulse/ no breathing... you cleared the airway just incase then left them. they are presumed dead, and not worth bothering with. you move on to people you can actually help.
In fairness, I learnt Battlefield First Aid in the Army, and it tends to be slightly brutal in its administration. It was good though, huge amounts of it were spent on improvisation!! Haha, are you scared yet??
according to 'the book' as it were, SSAC's position is very similar t BSAC's in that they say give 10 cycles of RB on the surface then tow, and administer CPR/EAR when they are landed.
just to cheer you all up. when i did my first aid training... in a mass casualty situation... if there was no pulse/ no breathing... you cleared the airway just incase then left them. they are presumed dead, and not worth bothering with. you move on to people you can actually help.
In fairness, I learnt Battlefield First Aid in the Army, and it tends to be slightly brutal in its administration. It was good though, huge amounts of it were spent on improvisation!! Haha, are you scared yet??
The standard now is CPR/RB and its 30 compressions / 2 breaths.
As per heartstart last week on the telly
From the SSAC website
Using a buoyant lift, raise a fully kited diver from 10m to the surface, support on the surface and demonstrate R.B. for ten cycles. Then tow 100m to boat or beach giving simulated R.B. and simulated CPR.
tow as fast as your wee legs will go,My theory is that give 2 breaths on reaching surface.The new chest compression ratios have now been changed to 30 to 2,so i think breaths without knowing the 02 is circulating is like farting against thunder.Get to surface,get to shore,get help then primary ABC's
dive granny
25-09-06, 21:16
Hello Mr T. Just read your profile. "Soft strong and very long". Is that not Andrex?:D Just kidding. welcome to CA.
thank you for your welcome
Only changed bout three months ago,its 30 to 2 for an adult and without reading it up its now 15 to 2 for children.And in either case dont waste time with the 2 fingers on the sternum nonsense just head for the middle of the chest.
Only changed bout three months ago,its 30 to 2 for an adult and without reading it up its now 15 to 2 for children.And in either case dont waste time with the 2 fingers on the sternum nonsense just head for the middle of the chest.
Hi Mr T whay about a dip sometime, Its been a while since u got wet?
I'm shure we can find u a trainee.....
academyofdiving
30-01-07, 19:08
There is no hard and fast rule when rescuing a real accident victim. You would have been taught this during your rescue course. Every case will have to be considered on its merits taking in to consideration the strength of currents, the swell if any, how far from the shore and how easy it would be to remove the victim from the water. The general rule is to administer rescue breaths while towing the victim back to shore. However when the victims heart is stopped and you can usually tell this immediately by their skin colour, which will be purple, it is often better to get them out the water as quickly as possible and begin CPR immediately. Obviously if it is going to take more than a minute or so to get them back to shore and their heart is still beating, rescue breats must be given. From experience I have learned that you need to be prepared adapt to any particular situation. Any rescue which saves a victim is a good rescue.
There is no hard and fast rule when rescuing a real accident victim. You would have been taught this during your rescue course. Every case will have to be considered on its merits taking in to consideration the strength of currents, the swell if any, how far from the shore and how easy it would be to remove the victim from the water. The general rule is to administer rescue breaths while towing the victim back to shore. However when the victims heart is stopped and you can usually tell this immediately by their skin colour, which will be purple, it is often better to get them out the water as quickly as possible and begin CPR immediately. Obviously if it is going to take more than a minute or so to get them back to shore and their heart is still beating, rescue breats must be given. From experience I have learned that you need to be prepared adapt to any particular situation. Any rescue which saves a victim is a good rescue.
How do you know their heart is beating..?
academyofdiving
31-01-07, 22:34
From personal experience there is a significant difference between a non breathing victim and one who has suffered cardiac arrest. It may not always be immediately obvious, but if a victim is purple and completely motionless, and you can get that victim to the shore quickly. In some cases it may be better to assume cardiac arrest and get them on the shore where you can administer CPR if required. Remembering of course that even if the heart is still beating, it will most likely be very weak and therefore difficult to find a pulse in water. If you have ever been involved in the rescue of a near drowning victim, you will know that it is not always as simple as the text books suggest. A victim whose lungs are filled with water will produce large amounts of foam from their mouth. When this is removed / emptied it will refill again very quickly thus making it very difficult to succesfully carry out in water rescue breaths. It may be necessary even on the shore when you have had the opportunity to raise the victims feet to drain the lungs, to breathe past the exiting water and foam. So it is very much the call of the rescuer whether it is better to try and give rescue breaths in water or just get the victim out the water where both CPR and rescue breaths can be combined, taking in all the considerations and circumstances I previously mentioned in the original post.
How do you know their heart is beating..?
academyofdiving
31-01-07, 22:36
From personal experience there is a significant difference between a non breathing victim and one who has suffered cardiac arrest. It may not always be immediately obvious, but if a victim is purple and completely motionless, and you can get that victim to the shore quickly. In some cases it may be better to assume cardiac arrest and get them on the shore where you can administer CPR if required. Remembering of course that even if the heart is still beating, it will most likely be avery weak heart beat and therefore difficult to find a pulse in water. If you have ever been involved in the rescue of a near drowning victim, you will know that it is not always as simple as the text books suggest. A victim whose lungs are filled with water will produce large amounts of foam from their mouth. When this is removed / emptied it will refill again very quickly thus making it very difficult to succesfully carry out in water rescue breaths. It may be necessary even on the shore when you have had the opportunity to raise the victims feet to drain the lungs, to breathe past the exiting water and foam. So it is very much the call of the rescuer whether it is better to try and give rescue breaths in water or just get the victim out the water where both CPR and rescue breaths can be combined, taking in all the considerations and circumstances I previously mentioned in the original post. In answer to the original question. The only way to check for a heartbeat in water is by feeling for a pulse. With a near drowning victim this can be very difficult.
How do you know their heart is beating..?
I would suggest forget wasting valuable time trying to find a pulse.
I would suggest forget wasting valuable time trying to find a pulse.
With dive gloves, forget trying to find a pulse and forget taking them off speed is important. Get the victim ashore and do it properly.