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Diver Rescue - Someconsiderations and Uncertainties

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Diver Rescue - Someconsiderations and Uncertainties CI{APTERTEN Diver Rescue - someconsiderations and uncertainties JohnLippmann Aboutthe Author JohnLippmann has beendiving for more than 20 yearsand has held scubainstructor clualifications rvithseveral agencies. He has specialisedin teachingdiver rescue,cleep diving and orygcrtadminjs- tlationcourses. He has been an instructor and examincr in oxygen resuscitation with the Royal Life- SavingSocieiy of Australia (RLSSA)for the past 10 years,and is the ImmediatePast Chairman of the QxygenResuscitation Panel of the Victorian Branch of thc Society..Tohn currentl.y rept'esents RLSS (Vic)on the Australian ResuscitationCouncil. He is also cerlihed to-teachoxvgen first aid courses untlerthe sanction of the Divers Alert Network, and is a cert.ifiedfirst aid instluctor". Johnis 1hema-ior author of Thc DESIDAN Em.ergenclHond,booh. and is the aulhor of DeeiterInto Diuing,Tlrc Essent.ia/sof Deepe,rSport Diuirtg and Or;gen Fi.rst Aid t'r;rDir:ers. all of wh ich havc gained 1'or.ldrvideacclaim. ,Iohn's numerous articies on diving safetvate publishedthroughoul, the rvorld. At some tjme, a ciiver rnay find himself jn a support or refirte the r"ationales behind certain sihration where it is necessary to tescue an suggested techniques. ln addition. diver rescue unconsciousdiver, either submerged or on the i-snot a black and whil,e situation q'hcrr: one set surface.Fortunately, such situations are rat'e.' of specific actions trnivcrsallv applies. I)ivers shoulcl be madc ar,vareof gerrei'alpt'ini:ipals of Sometlaining :rgenciesinclude a protocol for the rescue,so t,heyare bettcr equipped t,oadapt to a les(rueo{'an unconscious diver during their basic palticular situation, should it arise. ropenwater)divc course. Other agencies don't is 1,opreselnl, issLres teachthe shiils until the Rescue Diver level. The purpr.rseolthis chapter not have consider^ed.ancl Rescue and resuscitation skills are very that some divers mav discussion on this valuable tools that all divers should to encourage thought and acquire as soon as possitrle. Once learned, important toprc. theseskills need to be practiced reasonably One point 10 sen-sidcl is thc deglereof tirgencv often (ie at least twice annually) to main- of the s:il.uation.Whether'1.he outcome rvill bc a tain the required level of performance. possihlc rescLrcor a body le{to\r€rfv.-le:pettrds on a valiet.S'of factors, rvhich includel:{l I w'hel.hcl or The :rctrral plotocols currentlv taught vary not tlre divcr is still bleathilrg Ir'ont his rergrr- bttl,een agcncies, ancl from instructol to in- lator: (2ihor'r'much t.rnrelras r-'l:tpstttlsince tlte stluctor'.One common problem is that many dive: diver stopped brcathing; and 13) llrr: tempcra- $udents leave the colrrse rvith the berlief that tr.u'eof the rvatr:r and in.qulation of tl're clivc'r', lhcreis only one correct method to perfirrm such among other l'actors. afescue.Although within the time consl.raintsof The paltial pres-qlu'eof ox\igctl {pO I in ar'1,r:r'ial a commerciallvorientecl dive course it is olten thc brairt is norntallv 80-90 onlvpractical to train the students in one partic- hloocl suppJving When a pelson stops breatl'ring, Lrlalprotocol, the divers should be made awarre mmHg. pO- falls rapidl.y and ltv thc timer it reachcs that unconscious diver rescues are nol neces- the 40 mrnI{g, consciousrte,qsis selior,r-qlvin-rpailcd. salilv so straight fort'ard. There is still a lot ol uncertaintysurrourrding rrarious aspects of' diver Dr George IJalpur', a Canadian h-ype:rb:'rlic recovcrysince there is a paucitv of data tr-r phvsician, ha-qargued that it nornlallY talics I)lvER RItS(lLrli - Solv-lECONSIDtrRATIONS AND UNCIIRTAINTIES apllroximately 90 seconds from Lhe tirne con- diver is breathingand mav, or may not becon' sciousness is seriously impaired (40nmHgr, scious.The absenceof bubblesfol morethan fbr thc pO, to drop to ler.els lvhcre pernlanenl about 5-10 secondsindicates that a divel isnoi dam:lgc to the cenlral nervous system occurs breathing. A slumped position,eyes closed oL {trpproxin'ratelv 20rnrnIlg).' Consequentlv, Dr blankly staring mav indicate impailed con' I{arpul has sugecsted that, r,,l'rere po-*sible. sciousness.Gently shaking the djvel should lcscucr'-cshoulc[ aim to have lhe r-ron-brcathing, elicit a resporlsei{'he is ful[y conscious.A divcr inlured diver brought to tho surfilce ancl vcntj- u'ho cloesn'treact at all, or onlv reactsterr Iated rviihin .c)0seconds of losing conscjousness. u'eak1v,should be broughtto the surfat:e. Ilou,ever', altlrough this time fiame appears to bc re:rsonablt: on land, the situation m:rv be ver-yciiffcrent lvith a diver underwater'. Non-diving-casualLir:s have at tirnes made dra- matic and successf'rrltcco.,'eries atter rcsuscitir- tion tbllr.rwing long periods (up to about 60 minutes) of immersion rvithotrt bleathing in 'Ilre vcrv colcl waterr. lower oxygen Lrsage lesulting from the reducccl bloocl flow to thc rron-vital organs tcliving reflc'x) trnd slorvercl rnctabolic rate fi ()m hypotl-relnria.together' witl.r the higher oxygen partial pre-ssuresassociated rvith de.pth,have bcen used to explain thi-s plte' n0rnen0n. In scriesof 50 caseso['indivic[ials rvho ]rad onc Nrrrrnollr'. the lirst slrlt is to dclcrntine ttltalht'r or nattlr bet:n subnto'gccl in colcl n,atei' lbr periods o{' 'fhe betwcen six to sixlv minr,rtes.45 had sLrflciecl rescue.i' should get a firm grip on thr: no cletcr:tablencurojogical impairnrent atlrr iniured cliver',ancl tzrke a couple of secondstl being resLr,sr:itiltctland rervarrned.' Clonsc- compose himself and assess the best coul'.se0f clucr-rtly.it, is recommendcd that lesuscitatirtn action to takc. rvtiile quickly locating thrr ancl rcrvai'nring be :rtternpted on anv ca-cua]t]' cliver's rveightbelt :rnd BC int'late/dcflatemedi- n,ho has bc'en subnielgecl fil' up to 60 mrnutes anisms. Although it is important not to in rviLt,erof'21 C oi cooler. waste time, the few seconds taken trr Llnfoytunatelv, there is a lack of daltr to inclicatc' assess the situation may save unnecessarl' hor'vlhe rveaiing of'an cxposrlrr-'sr.rit arrcl chving complications down the track. ma-qk cf'fcct the sui'r'ivabilitv o1'a clivc'r rvho rs Whether the cliver i,s bleathing or not. thl unconscious.subnrergecl artd not,bre irthing. It is lescuer should suppor"t the regulatol in thr pr-rssibleth:rt strch cquipmc'nt could reduce 1.1-rc diver's moubh to ensure that it doesu't become 1.tre chance-qol sulvival bv delaying or reLlucing clislodged.Positioning tl-reinjr-rred diver''s head prtlcctive e{T'ectso{ hypothei'rnia and the cliving' with bacl<ward heacl tilt should maintain al reflex. zrdequateair:rvay. Consiclerlhe scclrariorvherc'a diver encorLntcrs Backn ard head tilt is nornrallv used to openthi an ap pi,lrerntly u ncr-rnsciousd i vel uudelrvatet. ainvay of an unconscious person on land. Wherr Norrnally, tl.ref rrst step is to detelminc u,hcther' an unconscious pel"sonis lying on hrs back,tht or not tlre drver is lc:r1ly unconscious. Tkris trav toligrlc falls :rgainst the back of the thloat and lre ctoneby approaching and quickl.v obselvit'rg can obstruct the ailr'vay. Tilt,ing the head back t,he cliver'. Erhaust bubbles indicatc that the nnd lilting the lorver:iau'minimises this. DIVER RESCUE_ SOMECONSIDERATIONS AND UNCERTAINTIES Somerescue protocols suggest that the rescuer The expanding air ivill force water through the shouldsupport the victim's head in a neutral victim's nose and into the throat, possibly position(i.e. not tilted back or forward).'n causing laryngospasm, if the diver is not fully Whetheror not a neutral head position will unconscious. providean adequateairway in this situation is If the mask is full of rvater. it can either be debatabie.It has been suggestedthat because rernoved underwater, or on reaching the sur- theunconscious victim underu'ater should nor- face.It probably won't make much difference. maliybe brought to the surface in an upright position,airway obstruction from the tongue is If the diver is breathing ancl the mask is lesslikely, and, therefore, a neutral head posi- removed, the rescuer can pinch the injured tionshould be adequateto allow air to enter the dir,er's nose to prevent water entering during lungsof an unconscious,breathing diver (with the ascent. anair supply), or to vent from the lungs of a Certain protocols suggest that the victim's breathingor non-breathing diver. One argu- weightbelt be removed.rj'qeThe injured diver is mentput forward against using backward head often heavy (many being substantialll,- over- tilt is that any water that has coiiectedin the weighted"')and it may be necessaryto remove diver'smouth could be encouragedto enter the his lveightbelt to increasethe diver's buoyancl,. throatif the head was tilted back. If the diver is If the victim'sbelt is removed.the rescuermust notfully unconscious,this water could cause a have a firm grip on the diver prior to removing reflexspasm of the larynx, known as laryn- the belt, as mentionedearlier. It is also a good gospasm.Laryngospasm may last for minutes. idea to locate the injured diver's BC inflate/ It usually abates as the diver becomes vert/ deflate mechanism, since it may save time shortof oxygen(deeply hypoxic).The likellhood finding it later. The weightbelt may then be oflaryngospasmdecreases as the injured diver removedand pulled well clearto preventit lan- lapsesfrrrthcr into unconsciousness. gling with other gear, and dropped. Iflaryngospasmis occurring during the ascent, However.not all lrescuersfind it necessalv.or- expandingair in the lungs may not escape desire, to remo\/e the victim's weightbelt effectivelv,increasing the possibility of'a pu1- undelwater.
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