Sutty

On the whole I like the flowchart, you have obviously put a lot of thought into it.

I still have a problem following the "mouthpiece out" side of the chart - having sealed the mouth, ascended punching out gas, if the convulsion subsides you are then asking for an assessment whether the victim is breathing, but you are sealing the mouth, expelled most of the lung content, and no reg is in place, so the victim can't breathe, and you will always go to the "ascend direct to surface" pathway, in which case you could simplify the chart.

However I would suggest that if the convulsion subsides it would be reasonable to continues to ascend (so lung gas is expanding and flooding the airway is less likely) and make 1 attempt to insert a reg at that stage before entering the 2nd half of the chart. This gives you a chance of entering the "victim is breathing" pathway which is likely to have the best chance of survival.

Punching out gas every 10m may be excessive - if the victim has a reasonably high FO2 in the lungs they at least have some O2 "reserve" to delay the onset of hypoxia - it would be a shame to remove all of this. I'd suggest expelling gas initially and then each time you halve the depth until 5m, this correlates better with the gas expansion in the lungs.

With seizures on land (epileptic, metabolic, head trauma, etc - I have no experience of O2 seizure) many patients can be very confused, agitated or aggressive as consciousness returns. So a breathing victim still doesn't mean you neccesarily have lots of time as an agitated victim may pull out a mouthpiece or reg and mask and tragically drown just as they are recovering.

Neil

P.S. 2nd box down on left has a typo "moutpiece" instead of "mouthpiece"

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