Bringing an unconscious Rebreather diver up from depth

db8us

I think first we might need a buddy to bring an unconscious diver up !

bendomatic

from my experience in assisting an unconscious non-breathing rebreather diver to the surface, all this talk of diagnosis underwater is a waste of time! I got to see from 6 inches away a diver convulse, recover try to bail out to OC reg, convulse again without reg in mouth, stop breathing, turn blue rapidly at 42m. Me and his buddy took him to the surface as fast as we could (to our own personal detriment). the diver was revived on the boat, choppered out (revived again) and taken to hospital.

now lets look more closely wrt to all this underwater diagnosis business. well obviously a convulsion was because he was hyperoxic -well it's not the whole story. it turned out hypercapnia started the chain of underwater events due to improperly packed scrubber, he probably was hitting the O2 button instead of dil at 42m in his confusion becoming hyperoxic, and when we were trying to help him, he became hypoxic. so which part of some some long-winded list of "if this, then do that..." do you start with? It's an academic exercise that when confronted with the realities of a diver dying in front of you, that mostly you will ignore. Whatever you end up doing Keep it simple. stick to the very basics of a rescue.

ScubaDadMiami you pretty much described exactly all the reasons this incident i was involved in, had such a positive outcome. Have some green! In the end I had to stop being part of the rescue as i had a blown out deco obligation (rapid ascent tripled overall deco requirement). I had to let go of a diver who was in desperate need of help. the toughest decision i had had to make. But others were able to step in and help.

There are always some things you might think later that you might have done differently but i don't live with any regrets that a fellow diver lived to see his wife and son another day. coming up to 4 years in two weeks, i don't think he regrets my actions either.

rachel

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decoweenie

Is this comment helpful when people are seriously trying to learn here ?

And the intended insinuation that all Rebreather divers are solo divers is way off base and not freaking appreciated!

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MHD

Simple review of 3 real cases

1 JasonM, showed problems at approx 110m early in dive, ascended by self to approx 30m, was escorted by another diver during ascent, went unconscious at 30m and was blown by buddy (who himself had significant deco obligation) to surface and recovered by boat crew. Was resus'd by crew and transfered to hospital. Showed signs of severe DCS hit among other symptoms. Has since made an almost full recovery. (Jason may say what his residual issues are I know he had some sometime back but no clue to there real extent, but involved a spinal hit I think)

Key item here was that diver had significant DCS obligation, but made basically a straight ascent from 100 in the end. The cause for his problem is immaterial to the subsequent management of the deteriorating and finally unconscious divers, but the key was once on surface was recovered by boat crew almost instantly and air way safety and breathing re-established. But the key thing was that once he went unconscious his time in water where he could drown was minimal. Unconscious diver under water = future drowning victim

Bent divers can be treated, dead divers can't be

Case 2

Myron Wyntonik

Grand mal seizure at 42m early in dive, lost loop, teeth clenched so unable to put reg in mouth. Was bought by divers straight to surface and back of boat where resus was commenced. Was resuscitated but had recursive drowning, and was choppered out and resus'd by para's on several more occasions.

Was released from hospital and walking and basically physically fine the next day. Key element was that while air way was unprotected, total time was probably about 90 second with either loop out or breathing water. Again time is everything with an unconscious diver. Drowning is your worst enemy. Myron had no DCS symptoms, was chambered as a precaution for a AGE. Total time on bottom was less than 5 minutes so this is not unexpected

Case 3 Rob Cook

Grand mal seizure at 3m at end of dive, no deco obligation, Was in process of bailing out , but hadn't managed to get reg in by time of seizure, so breathed water, was instantly taken on board a boat and resus'd (ie brought to surface unconscious and not breathing). Choppered to hospital and released the next day.

All 3 are successful cases where the air way was compromised. In at least 2 cases there was nothing you could have done to restore gas quality to loop, for varous reason I wont explain (it may of made no difference in the third either).

The key is the longer the time underwater the unconscious diver spends the more likely they are to die. Very simple.

These successful cases all have one thing in common. They got to the surface ASAP (all well less than 90 seconds from point of unconsciousness), and got subsequent help that meant they lived. Screwing around trying to solve other non important issues is the same is finding interesting ways to kill them.

If you take 3 minutes to get diver with a unprotected air way to the surface (ie reg out) it is all over in practice.

If you take 3 minutes to get a non breathing diver to the surface it is all over

If you can not guarantee the diver is breathing, get them to surface, who cares what their loop is or there Deco obligation. The loop it is the most likely reason they went unconscious, so get them to the surface and breathing air ASAP. Every second you screw around it is more likely they will die. DCS can kill but drowning is faster. DCS can be treated post event, death is a little more hard to rectify. Drowning is the biggest risk at this point, manage that and you will have a hope.

There are several stories floating around about people trying this and that underwater with a unconscious Rebreather divers, and they all result with the death of the Diver, the successful cases all have one common factor, minimum time with the air way compromised.

There will always be the odd exception. but for me having known 2 of the above people and being full informed of the events (case 2 and 3), this the ultimate application of the K.I.S.S principal.


Matthew

decoweenie

Matt,

Thanks for the detail and informative post.

Would you agree that surface support was the second important factor that saved the divers in all 3 cases (after the most important factor - sending the diver up, per your post) ?

If so, then what should be the alternative when diving in conditions where direct and immediate surface support isn't available ?

For example, in ripping current where the diver could be swept away very quickly and not spotted from a distance, or during a scooter dive that covers a long distance from the dive entry/exit point...

The reason I asked is I don't think our boat would have spotted Rob if I had just sent him directly to the surface, it was dropping another group of divers some distance away. And there was some current on the surface as well...

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"...after a while you get bored offering advice to a bull that like to keep butting the fence with its head rather than walking through the open gate..."

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bendomatic

unfortunately there will always be some circumstances that mean the outcome will not be good regardless of how hard you try. it's whether you can live with yourself in the knowledge of what you did (or didn't do).

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Gilles

Here you have a circumstance warranting immediate surfacing... convulsing with loss of airway. This is appropriate for that particular circumstance.

Peculiar about Rebreather's is there are scenarios where an unconcious buddy, but breathing (thanks to either a FFM or good neckstrap) should undergo an alternative rescue procedure in order to avoid further unnecessary injury.

This is particularly important for me as I apply the advice from this forum in advising my skilled OC buddies on how to rescue me. I have a BOV, and a good neckstrap that firmly holds my mouthpeice in. If I'm found convulsing, or unconcious, with a deco obligation, why should OC rescue techniques apply?

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Gilles
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MHD

because their ability to manage your airway irrespective of what you think will always be questionable. On top of that they really have no idea why you went unconscious to start with. They can guess several things and get it wrong (and in all the cases I mentioned people guessing would of most likely got it wrong, case 1 you had a hope, but even knowing the person couldn't do anything about it) and all this time you will be in the worst possible location for treatment.

Phi, you are right, in all cases mentioned the events where resource rich, ie lots of people about to assist (and with knowledge of what to do) and in 2 case diver taken direct to boat and the third the surfaced in view of the surface watch and very close to hand. Sending someone to the surface with no one there is highly unlikely to result in their survival. To me it is a very simple series of decisions to maximise their chance of survival. If surfacing away from the boat you have to be prepared to stay with the diver to protect their airway until the boat can get you. Your chance of doing EAR in water is minimal. Not impossible but not good. Chance of doing CPR is zero. So if faced with surfacing away from the boat you have to be prepared to incur the deco hit, as there is no point going to the surface if you have no intention of staying with the diver until the boat is contacted and on hand. That could be 1 minute, or it could be 10 minutes. If you aren't prepared for the deco hit, let them go. Or if you think you will be in shouting distance of the boat you may decide to go up, scream for the crew, then descend to do deco and establish positive buoyancy face up for the victim before leaving (say 1 minute on surface).

In the end of the day if you have 3 m seas, strong current and expect to surface well away from the boat the person chance of survival is very small and you might have to start consider your own position as with a serious deco obligation you will definitely up end with with 2 victims out of contact with the boat, not one. The longer it takes for the person to get on the board and get treatment the less likely the chance of survival, and at the same time the higher chance the rescuer will become potentially a second fatality if they go to the surface. At some point you have to make that trade off and let them go to protect yourselves.

Honestly if you have FFM, OC gas and switch block to do it you may get some one through deco, you may make it work, but other than that you are kidding yourself. but saying keep me on the loop and in the water when you went unconscious on it is dumb.

Matt

bendomatic

if my brain function is compromised as evidenced by convulsions and or unconsciousness, i don't want my buddies to faff about trying to decide what to do. i want them to get me to the surface as safe as possible (that would end up being determined by them- after all i'm unconscious). if you're happy with you're buddies to do whatever you tell them then that's yours and thier perogative. Your Rebreather doesn't make your brain any less vulnerable to damage. you're assuming that whatever caused the unconsciousness is going to mitigated by the fact you have a strap on your head and your OC/BOV gas is going to help. it might, it might not - i can think of at least 4 scenarios that it won't make diddly squat difference. You're also assuming that your condition won't deteriorate and that your buddies will be able to tell easily when that happens (and hence change what they do with you!). can you tell my why OC rescue techniques can't be applied to the RB diver? i'll take on being bent over dead any day.

rachel

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Gilles

I agree on the first point, but with a BOV fitted, there are no diagnostics to get wrong. My airway was managed by my self by the bailout mix and volume I made.

I'm unsure of what you mean in your 2nd paragraph? I assume you mean one is kidding himself without BOV/FFM/NS.

I say keep me in the water whilst I am clearly breathing out of my 2nd stage until your own deco is done.

Immediately switching a BOV is not faffing about. Accompanying me to the surface until your own deco is done, whilst I'm unconciously breathing is pretty safe and successful, no? Perhaps there is some confusion here.

I want to instruct my buddies on how to save my ass if I need them. Lord knows they are well covered if I'm rescueing them. I'm having this discussion to allow you to influence my opinion on how I should instruct this. Please try to limit your antagonism.

Mitigate does not imply 100% effectiveness. A BOV is an effective way to get a safe gas into my lungs, and a neckstrap(or FFM) is a fairly effective safeguard for ones airway. In reality, we only partially mitigate against all things that can harm or kill us.

One thing that can both harm and kill, is an overly simplistic approach. I'm all for K.I.S.S., but there is also KLUDGE that may cause much unnecessary harm.

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Gilles
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