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Old 18th January 2008, 10:39   #21 (permalink)
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Re: Standardizing CCR Rescue Skills

Quote: (Originally Posted by Steve) View Original Post
Sometimes the simple answer to handling buoyancy and PO2 issues is well.....simple.
If the rescuer cant handle it, bailout and deal with them then. By all means have a shot at leaving both parties on the loop but it will be much easier if the rescuer is OC and knows CC.

Wont going OC just add gas switching and re setting your deco computer to cope with the fact your now OC, to the task loading? Then you have to switch the unit off or isolate 02 feed on the KISS to stop it filling the counter lungs. Finally, empty the counter lungs before you go OC or they will expand and cause buoyancy issues.

Even if you empty the lungs it likely they will need to be emptied again on ascent so you will need to dump them or suck them empty which will mean you need the gas your emptying out to be life supporting.

Personally I would find being on ECCR an advantage during the lift. Slightly harder on MCCR but my HUD will help

If we were to introduce a standard to make lifting a diver easier Id suggest starting with a gaged loop.

Holding the loop in the divers mouth whilst performing all the other tasks is going to be the hardest part.



Hears how Janos showed me and it seemed to work OK. i have added the SMB bit my self


ON MUST do deco dives only
Send up a SMB

Use double ender and clip on to free running SMB line and to divers chest D ring. Just let the reel dangle


Face to face with the diver

Right hand grabs the harness on the divers left shoulder

Left hand operates all injection dumping etc.

Open the divers OPV all the way

I dump all my own wing

I inflate the divers wing to lift using my left hand

Having obtained upward movement Ill orally dump my own counter lungs manually pull dump his and immediately get PP02 on target for both of us.

I doubt if I would let ascent rates exceed 5m/min

On a stop use the smb line to tie off diver at X depth. A couple of loops around a valve should do it. Then you can hang a little negative. I think the chances of doing free hanging deco are minimal.


Chances of this working I reckon are 50/50 at my skill level.


ATB

Mark
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Old 18th January 2008, 12:45   #22 (permalink)
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Re: Standardizing CCR Rescue Skills

Quote: (Originally Posted by Mark Chase) View Original Post
Wont going OC just add gas switching and re setting your deco computer to cope with the fact your now OC, to the task loading? Then you have to switch the unit off or isolate 02 feed on the KISS to stop it filling the counter lungs. Finally, empty the counter lungs before you go OC or they will expand and cause buoyancy issues.

Even if you empty the lungs it likely they will need to be emptied again on ascent so you will need to dump them or suck them empty which will mean you need the gas your emptying out to be life supporting.

Personally I would find being on ECCR an advantage during the lift. Slightly harder on MCCR but my HUD will help

If we were to introduce a standard to make lifting a diver easier Id suggest starting with a gaged loop.

Holding the loop in the divers mouth whilst performing all the other tasks is going to be the hardest part.



Hears how Janos showed me and it seemed to work OK. i have added the SMB bit my self


ON MUST do deco dives only
Send up a SMB

Use double ender and clip on to free running SMB line and to divers chest D ring. Just let the reel dangle

Face to face with the diver

Right hand grabs the harness on the divers left shoulder

Left hand operates all injection dumping etc.

Open the divers OPV all the way

I dump all my own wing

I inflate the divers wing to lift using my left hand

Having obtained upward movement Ill orally dump my own counter lungs manually pull dump his and immediately get PP02 on target for both of us.

I doubt if I would let ascent rates exceed 5m/min

On a stop use the smb line to tie off diver at X depth. A couple of loops around a valve should do it. Then you can hang a little negative. I think the chances of doing free hanging deco are minimal.


Chances of this working I reckon are 50/50 at my skill level.


ATB

Mark
Now that sounds like common savvy to me - I can't think of anything worse than going OC to lift someone from depth and having to worry about how long my ally 11s or steel 7s will last - especially when the adrenallin kicks in, breathing rate hikes etc etc ......

For the most part (and there are exceptions) a longer deeper dive is the one to cause the issues of CO2 and O2 etc - meaning usually longer deco and depth etc ......

I would do my best but would stay on eCCR (leave the Meg to hold 1.2) as I forget holding 1.3 manually - my OPV is fully open from bottom, drysuit self dumps and I would also lose wing buoyancy - I can then concentrate on my bud and stops etc.

Anyway, all theory goes straight out the window in reallity and leaving most of my kit as is sounds like the simplest and quickest.

An interesting thread - hope I never have to use in anger !!
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Old 18th January 2008, 12:47   #23 (permalink)
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Re: Standardizing CCR Rescue Skills

It's good to see this thread has a lot of you thinking more deeply about this subject.

Judging by the posts I think think it's very easy to see raising an unconscious diver from depth is going to be a real struggle and definately a skill which needs to be discussed and practiced if it is going to be used with any chance of a successful outcome. Add to that hanging at a deco stop whilst holding your buddy's BOV or DSV in place and maintaining your buoyancy at the stop is going to be extremely difficult.

Matt and I did an unconscious diver at the surface drill and it was very clear that it is almost impossible to maintain the incapicated divers airway in even the slightest surface chop with the diver on his back with the unit on.

Keep the thoughts coming and if there are any other instructors out there who would like to put their thoughts forward I am sure we would all like to hear what you have to say.

Regards,

Lance
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Old 18th January 2008, 12:53   #24 (permalink)
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Re: Standardizing CCR Rescue Skills

Diving Rebreather is more complex than OC so a rescue on one will also be far more complex. I think that we would first need to separate tech from sport. Sport diving with no deco and shallower dives possibly makes it a different type of rescue. I am not sure if better or worse. Tech theoretically would have less panicked divers but more complex dives, deeper water or over head environment, and deco but more gas supply and hopefully team support, unless we are talking extreme tech diving then who knows? Whereas sport diving there could be more panicked divers shallower water. No deco but more mistakes?
Sport Diving:
It seems first problem is managing a controlled accent during rescue, be this slow or fast depending on the scenario and depth. Hopefully we all agree that each diver is caring plenty of OC bail out, and that when in doubt bailout. If we can’t figure out a way to do this then in my book it is not a rescue. By no means am I saying that I want my buddy to risk his life, but with practice and all of our experiences we will hope fully figure this out. If you’re the type that figures you are diving solo regardless of having a buddy or not and that you just save your self, then please don’t dive with me. I like solo diving but I also like to use the resources available.

Unconscious diver at the surface:
Once victim is off the loop and loop is closed. surface rescue would seem to be a standard out of the book surface rescue.

Surface rescue is a standard surface rescue same as one before.

All the other ones mentioned seem to get more complex on a rebreather

Unconscious diver at depth:
Is it do to Hypoxia Co2 or even O2 after a toxing out we didn’t notice because we were to busy taking photos. We could verify that his breathing gas is breathable. Here is the problem if it is not breathable do we try to fix it. ?? To Flush, or not to Flush! Or do we just ascend. Get diver to the surface. So now we would have come up with a means of doing a controlled accent. Can a controlled accent be done with just one buddy in calm sea no current wearing a wet suite from depth I think so. Can it be done with dry suite a current and rough seas and one buddy? That would be much harder if possible at all, so would the same standard be valid for all divers in all situations? Probably not. So is it possible to make a universal standard? I really don’t know what do you guy’s think?

Panicked diver at depth.
The ideal would seem to be noticing the problem before it gets out of control. Once it dos al we can do is try to cope with the issue, if we can’t then hope he remembers the most important rule in diving.

Oxygen Toxicity -Convulsions
If the victim is convulsing and maintaining neutral buoyancy, highly un likely but possible. Diver might be on the bottom when convulsions start, then it could be a mater of waiting till it is over. and then ascending slowly to the surface, that would drop his Po2 by lowering the surrounding pressure, and there would probably still be plenty of O2 in his loop. If we can’t just wait it out, say we are over deep water or have a strong current, then How much we can help the victim would also depend on the severity of the convulsions the conditions around us our gas supply and the depth. Has any one had experience trying to keep a convulsing diver from losing neutral buoyancy during the episode? If I understand correctly it is quite short, and not always violent. So providing he had a tendency to clench hi teeth on the DSV and not spit it out, or if he did lose his DSV his buddy plugged a reg in his mouth before that initial inhalation after the convulsions. It could be better than a fast solo trip to embolism land. A problem would be over deep water and losing DSV then he is on the fast track to the bottom do to flooded CL and buoyancy loss. Now providing the buddy had sufficient gas supply he would have to decide if to risk going in to deco to recover him,or not! I guess it would depend on the circumstances.

CCR diver with Hyercapnia
If he has Hypercapnia only possible action in sport diving is to bail out to OC. And the dive is finished. Fixit at the surface don’t fiddle with it under water.

The other rescue not mentioned was Caustic Cocktail, and that would be just a bail out situation, unless the victim is to stressed and sick and needs assistance. That would also be a controlled assent by the buddy. Or if to bad a rapid assent.
Tech would have all the same considerations plus the added complexity of a ceiling be it deco or over head environment, and gas changes on bail out. Sorry this got longer than I planed. Promise I will shut up know.

Last edited by Robert Landreth; 18th January 2008 at 13:13..
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Old 18th January 2008, 14:32   #25 (permalink)
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Re: Standardizing CCR Rescue Skills

I'm not sure that we want to be just standardising CCR rescue skills. I would suggest that the topic should be "Standardising Technical rescue skills"
The sort of diving I do, it could be an OC or CCR diver either being lifted or having to perform the lift. So my sugestion would be that any student on a technical course (either CCR or OC) practice lifting both OC and CCR casualties.

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Old 18th January 2008, 16:21   #26 (permalink)
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Re: Standardizing CCR Rescue Skills

Just to say that the lift I showed Mark was the standard BSAC CBL (Controlled Buoyant Lift). On OC I really am pretty good at this because I teach it regularly which gives me lots of practice and I can hold a stop within a foot or so. I burn through gas though.

On OC there's only one source of buoyancy to control - the BC (go vertical and the drysuits dump automatically and my wing is emptied at the start of the drill.)

On CC I find it much harder as I now have to control the counterlung volumes of myself (relatively easy) and the casualty (much harder). I end up dumping the wing more than I would otherwise to compensate a bit for the expansion of the counterlungs.

If I were deep, and I knew for certain where the shot was, then I'd seriously consider going back to the shot to give some sort of support.

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Old 18th January 2008, 18:00   #27 (permalink)
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Re: Standardizing CCR Rescue Skills

A mere suggestion:
A list of standardized Rebreather rescue skills could and should be established to cover RB sport diving.

As far as technical diving goes though, I think the rescue training philosophy should focus more on teaching how to develop, include and adapt a rescue plan into the dive plan. This rescue plan can then be adapted by the divers involved to the specific units, depth considerations... involved in the technical dive. We all plan our deep dives anyway, don't we? Why not adding a 2min. rescue brief before splashing, then it's fresh in the diver's mind too.
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Old 18th January 2008, 23:40   #28 (permalink)
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Re: Standardizing CCR Rescue Skills

Guys its all good stuff keep it coming,

I'm am working on a power point presentation to use during Mod 1 training ( CCR rescue) and will upload it when I'm finished for your thoughts.

I will also try to put something together around technical rescue when I get chance

Thought of the day.

Something as simple as in-water rescue breathing at the surface becomes a real challenge when both divers have over the shoulder counter lungs, they generally need to be remove to allow access for the breaths to be effective. Not all unit make this a simple task.

Cheers for all the imput
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Old 20th January 2008, 15:37   #29 (permalink)
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Re: Standardizing CCR Rescue Skills

Hello,

This issue has been discussed many times in the past. It is also a subject of interest within the scientific diving community at present. For these reasons, it is likely that the Diving Committee of the Undersea and Hyperbaric Medical Society will convene a workshop to address the issue at the 2009 Annual Scientific Meeting. This is unofficial at present, but as the committee chair, it is something I am aiming toward.

I do not wish to comment comprehensively at this stage, but will repeat a couple of observations I have made in the past.

First, it is implied by many of the above proposals that an unconscious diver's airway can be safely managed underwater. This is an extremely optimistic viewpoint, even for short periods of time. Airways in unconscious subjects are hard enough to manage on an operating theatre table in ideal conditions with all the appropriate equipment. The idea that you can preserve a dry airway in an unconscious diver underwater for any length of time whilst trying to manage all the other issues (that many of you have correctly identified) is, well, not very credible. Even if the mouthpiece is in place, how can you tell that the diver is breathing, or that the airway is not already full of water? My own very strong opinion is that an unconscious diver needs to be on the surface out of the water no matter what their decompression obligation.

How you get them there is a problem. A rapid escorted ascent is best, but if that represents too much risk to the rescuer, then a buoyant unescorted ascent is less risky than holding the victim underwater for a prolonged period in my view (obviously there is no data to drive our practice in this situation). There is no doubt that this carries a risk of arterial gas embolism, but the risk is smaller than is implied in these forums. No disrespect to the poster of the earlier case report, but the diagnosis of arterial gas embolism in that case may not be accurate. Arterial bubbles found at post mortem in a diver who has omitted decompression may have formed after surfacing from dissolved gas, and may have nothing to do with pulmonary barotrauma. This is commonly misinterpreted by medical examiners as "arterial gas embolism".

There are many examples of divers making buoyant unconscious unescorted ascents without suffering gas embolism. In fact, I have treated about 10 in my career, and have never been convinced that any of them had embolised... though most had some degree of drowning. In fact, the main danger in my view is that they will arrive at the surface and not be noticed, therefore drowning there.

Finally, as I have said on many occasions, the belief that a convulsing diver must be held underwater until the convulsion has passed is a misconception and possibly a dangerous one in my opinion. The airway is not spasmed shut during the clonic (jerking) phase of a convulsions as is popularly believed by divers. I have manually ventilated patients suffering seizures, and the mere fact that patients can survive 30 minutes in status epilepticus tells us the same thing. In addition, there are some nice animal studies that reveal a degree of inspiratory obstruction during seizures, but no expiratory obstruction which is all that matters in the diver rescue context. It follows that the clonic phase of a seizure may be a good time to bring a diver to the surface. The airway is open, but they are not breathing (and therefore not inhaling water). Expanding gas during the ascent will tend to keep water out of the airway. So long as it can escape it should do no harm. Waiting until the end of a seizure when respiration resumes with an unprotected airway may be the wrong thing to do. This is one of the issues that will be addressed at the workshop.

Finally, and to put a lot of this into perspective, it is important to understand that the unconscious diver underwater is in a perilous position, and that no matter what you do (be it the perfect solution or not) the situation is likely to have a bad outcome.

Warm regards,

Simon M
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Old 20th January 2008, 16:06   #30 (permalink)
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Re: Standardizing CCR Rescue Skills

Assuming the diver has passed out from lack of 02 or blacked out from C02 is there no possibility he will carry on breathing?

There have been some instance of divers found with their units devoid of gas but otherwise apparently working and i am sure one or two were described as still having the loop in place.

I also remember an incidence reported on RBW where a diver (shooting video i believe) passed out and when he woke up he was back on the boat having been rescued by his fellow divers from the bottom.

These cases seem to imply that there is a chance.

I have to say Id like to think I would give it a damed good go before I gave up

That said I am acutely aware of the recent incident where and unconscious diver was rescued to the surface successfully but the rescuer died. I have a suspicion that the speed of the ascent was the cause of the diver blacking out. If this does turn out to be the case then I would have to seriously consider my responsibility to my family before I decided to ascend that last 21m.

ATB

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