Question about getting a blackoutee to the surface.

[naiad]

About the Heimlich maneuver, I don't know how it would be useful in a diving scenario because I think it would be very unlikely that the blackoutee would have their lungs full of water. Even if he/she did inhale some water, it would probably be a relatively small amount, enough to cause laryngospasm and other problems, but not enough to prevent any air from getting in.

I would use the rescue method that I have been taught.

I agree with Roland that a CPR situation should be avoided at all costs. An efficient rescue is the best way to prevent this.

Certainly worth learning the Heimlich maneuver though.

Lucia

[Mr. X]

Originally Posted by naiad

About the Heimlich maneuver, I don't know how it would be useful in a diving scenario because I think it would be very unlikely that the blackoutee would have their lungs full of water. Even if he/she did inhale some water, it would probably be a relatively small amount, enough to cause laryngospasm and other problems, but not enough to prevent any air from getting in.

I believed the idea is to quickly remove that small amount of water trapped by laryngospasm -- otherwise you are fighting the laryngospasm as it tries to resist the ingress of trapped water into the lungs as you give mouth-to-mouth. However, reading further on this, I see now that water does indeed enter the lungs sometimes & that 4 Heimlichs can be used to clear the lungs. [Although not everybody is convinced yet, incl. some on this Yorkshire Divers discussion (incs. earlier reference & nurse advice)].

I learnt first aid decades ago -- I know the specifics have changed considerably in that time (my dive instructor friend is also a qualified first aid instructor & we talk about it) & practice varies by region and organisation. When learning mouth-to-mouth, there was no real way to practice it safely at that time -- I always feared that it would not work if I ever had to use it. It is a reasonable fear, as I believe people often do not tilt the head back sufficiently to open the airway. Perhaps, you can get away with it sometimes...but if water is also trapped in there, seems like the odds are moving against you. I thought it was interesting that the Heimlich article mentions that clearing the water if often sufficient to get the victim breathing again (& let's face it, who wants to give mouth-to-mouth, unless absolutely necessary).

Originally Posted by naiad

I would use the rescue method that I have been taught.

I agree with Roland that a CPR situation should be avoided at all costs. An efficient rescue is the best way to prevent this.

Sounds sensible. Sometimes it is necessary though (that's when the training pays off).

Originally Posted by naiad

Certainly worth learning the Heimlich maneuver though.
Lucia

A quick & easy way to save a life or two. Don't leave home without it!

[Mr. X]

Originally Posted by fpernett

Heimlich maneuver is useful for solid foreign bodies in upper airways, but has no utility in liquid bodies, in fact, this is not included in RCP guides for near-drowning, of the AHA. Here is an article that explain it better J Emerg Med. 1995 May-Jun;13(3):397-405

Great post Frank (I missed it earlier)-- just one point, the Heimlich organisation (see earlier links) specifically includes rescue from drowning as a recommended use. However, I take your point that many orgs. might not include it or recommend it for that purpose. I only came across it being used for drowning 2 years ago. [Try searching Google on: "Heimlich first aid drowning" & you find links like this from the relative of a drowning victim & this on the history of CPR for drowning with specific references for AHA & Red Cross use, through Y2000...apparently they were, understandably, a little slow on the uptake].

[fpernett]

Originally Posted by naiad

About the Heimlich maneuver, I don't know how it would be useful in a diving scenario because I think it would be very unlikely that the blackoutee would have their lungs full of water. Even if he/she did inhale some water, it would probably be a relatively small amount, enough to cause laryngospasm and other problems, but not enough to prevent any air from getting in.

Well, it depends, in the early phase is uncommon but after some minutes the laryngospasm will cease and there is possibility that huge amounts of water come into the lung. It's not the amount it self what causes the problem is mainly the osmolarity of it that causes problems not only in the lungs. But you never will take out a lung full of water with the heimlich maneuver, is more easy that you take out the lung than the water with in.
The laryngospasm is a reflex, that occur even without any enter of water, and of course this make a mouth-to-mouth resuscitation quite difficult, but the pressure is not forever and with an Ambu you can ventilate it

Originally Posted by Mr. X

Try searching Google on: "Heimlich first aid drowning" & you find links like this from the relative of a drowning victim & this on the history of CPR for drowning with specific references for AHA & Red Cross use, through Y2000...apparently they were, understandably, a little slow on the uptake

I'll not trust everything that I find on the internet. I recommend you to do a search on PUBMED that will return more reliable literature.

[Mr. X]

Originally Posted by fpernett

...I'll not trust everything that I find on the internet. I recommend you to do a search on PUBMED that will return more reliable literature.

Good point (why should I trust PUBMED though?!? ...Or you? ). The Heimlich is obviously a controversial issue with several vested interests (& probably some inertia - not nes. a bad thing) competing (also check the dates -- organisations change their policies, both ways). More political than scientific. Sounds like Heimlich is not generally recommended for drowning though (unless airway obstructed):
e.g.
Controversy mentioned & technique details: http://www.lifesaving.com/issues/art...ntroversy.html
The case against (including death of a 10 year old boy): http://lfsv2.securesites.net/vboard/...light=Heimlich
The case against - 2000 Red Cross and Ellis & Associates change away: http://lfsv2.securesites.net/vboard/...light=Heimlich

There are plenty of dodgy "scientists" and doctors about it seems . Unlike the Dr. in Australia finding that antibiotics cure ulcers -- odd that no body tried that before (ulcer drugs being the most lucrative prior to that - with daily requirement for the patients remaining lifetime) .

[naiad]

There is also the problem of accidentally causing injury. Of course, it's worth it to save someone's life, but it wouldn't be good to come round from a blackout with broken ribs and a ruptured spleen because of someone's attempts to remove inhaled water.

Injury caused by misguided use of the Heimlich maneuver...
http://news.bbc.co.uk/1/hi/england/2587739.stm

The links posted above by Mr X are interesting.

Lucia

[Mr. X]

Originally Posted by naiad

There is also the problem of accidentally causing injury. Of course, it's worth it to save someone's life, but it wouldn't be good to come round from a blackout with broken ribs and a ruptured spleen because of someone's attempts to remove inhaled water.

Injury caused by misguided use of the Heimlich maneuver...
http://news.bbc.co.uk/1/hi/england/2587739.stm

The links posted above by Mr X are interesting.

Lucia

Interesting article. You have to wonder what the guy was thinking ...& doing to have broken ribs. The Heimlich goes around & under the ribs; pressure is applied under the diaphragm, not to the ribs at all. I did it to a friend in a restaurant as a group of colleagues sat round watching the guy choking & changing colour (he was a big fit guy though, 6ft 2"). I asked him if he wanted me to do it & he nodded approval...rather urgently. He assures me I saved his life every time I see him. Asking permission seems a sensible first step (which they don't teach strangely).

Heard a case on the radio this week where a guy was telling how a 92 year old relation (grandfather/uncle/?) had a good death when he collapsed visiting the toilet at a restaurant with his family, having just told his niece who accompanied him how much he loved her. The narrator criticized somebody who tried to revive him, for spoiling an otherwise good death. Not sure what the lesson is from that -- be careful & ask permission perhaps.

The back slapping they recommend is explicitly not recommended by Heimlich (for whatever that is worth!) but I tried it on a choking infant & it did not work at all, much to my dismay. I did not use heimlich though...don't recall why, probably did not want to risk causing injury on so small a child & prob. could recall the special technique for infants. I cleared his throat with my finger, which fortunately worked, but he did not start breathing again immediately ...continued turning blue. A sudden shock (arrival of emergency services) frightened him into a sudden intake of breath, followed by a loud scream! Phew.

[naiad]

Originally Posted by Mr. X

The Heimlich goes around & under the ribs; pressure is applied under the diaphragm, not to the ribs at all. I did it to a friend in a restaurant as a group of colleagues sat round watching the guy choking & changing colour (he was a big fit guy though, 6ft 2"). I asked him if he wanted me to do it & he nodded approval...rather urgently. He assures me I saved his life every time I see him. Asking permission seems a sensible first step (which they don't teach strangely).

I agree that asking permission (where possible!) is important. After some bad experiences in hospitals, I am very scared that if I have an accident, I will be given painful treatment which I don't want, and there will be no way of avoiding it.

I saw that in a book of diving first aid (can't remember the title) it said to always ask permission before giving treatment, and also to explain what is happening.

Of course if someone is unconscious or in an altered state of mind, this might not be possible.

Lucia

[portinfer]

Sorry to go back to the weight belt issue but I was wondering what people's thoughts were on rescuing someone who was spearfishing and was more heavily weighted than a freediver.

As a freediver you may encounter this situation I guess.

Anyway, lets say it is in relatively shallow water. The guy has weighted himself to be neutral at 6m but has come across a great patch at 15m and dropped down for some aspetto, gone over time and blacked out.

So if you were a buddy spotting him or a freediver watching him you would just see him spasm on the bottom I guess ?

I understand that deeper blackouts are very dangerous but I was wondering what the problems would be in such a situation (of course you would have to get to him, ditch the belt, ditch your belt and head up).

I am curious as this describes a potential situation for my local conditions.

Or is it the same if you blackout at 15m or 30m ? I just assumed that around the 10m to 15m range you had more leeway for recovery ?

Ed

[immerlustig]

hi ed,

i am not spearfishing but here are some ideas anyway.
you don't necessasrily see the diver spasming before bo, there can be a variety of signs or no signs at all, which is rare, though. or you fail to see them, which happens a lot. being neutral at 6 and diving to 15 won't make the diver very heavy, really, but you should try that. dropping a weightbelt is always an option in any case but for spearing you might want to make it a habit.
is the safety diver usually surface spotting? if there are chances that the diver overstays at depth and bo's there (lying around waiting for fish?) then the safety diver should spot at depth (descending after 1 minute, for example). the spearing depth shouldn't be deeper than the depth from which the spotter can still efficiently rescue the diver. and maybe there shouldn't be deep water but rather a bottom.
blacking out deeper can lead to more complications (longer ascent, greater possibility of water in the victims lungs, longer bo, etc). see above discussion.
low vis? is the spearo diving on a line which the spotter could follow down? if you are diving with the same people it should be easy to work out a routine.

would be interesting to hear some comments from other spearos.

roland

[ROBERT REYES]

Take the WEIGHT BELT OUT, it makes life so much easy, and laringospasm reflex will keep the water out.
I have taken a few divers out, spearfishing most of the time, so it took a few seconds to get to them, no matter what, its always a diferent situation and you have to improvise acordingly.
When pure freediving, is actually very easy, you are right on top of him, and
swiming with him to the surface, just let the weight belt go, (diver should be buoyant at this point anyways) and get his face out of the water, talk to him, he will recover fast , or give 2 air infussions in case it is taking too long to breath, dont panic, be calm, and keep telling him to breath.
Being alone, is were the real problem is.

[Mr. X]

Originally Posted by naiad

I agree that asking permission (where possible!) is important. ....Of course if someone is unconscious or in an altered state of mind, this might not be possible.

In which case let them die...and avoid the potential lawsuit?

[naiad]

I meant, just go ahead with the first aid!

"Do you want me to rescue you... no answer... well, I guess you don't..."

Notice to everyone: if I black out, please do rescue me, even if I don't ask for help. There won't be any lawsuit!

On the weightbelt issue, surely if both weightbelts are ditched, it wouldn't be too much work to get to the surface? There would be a big increase in buoyancy.

Lucia

[Mr. X]

Originally Posted by naiad

I meant, just go ahead with the first aid!

"Do you want me to rescue you... no answer... well, I guess you don't..."

Notice to everyone: if I black out, please do rescue me, even if I don't ask for help. There won't be any lawsuit!

On the weightbelt issue, surely if both weightbelts are ditched, it wouldn't be too much work to get to the surface? There would be a big increase in buoyancy.

Lucia

Hey - no signed consent form, no CPR!

[ROBERT REYES]

Well, I had to kiss my Frech buddy to wake him up, at least that is the
way everybody laugh at me about it, but his lips were black, he was not
breathing, his weighbelt had to be cut from him, because he used to lock it some way, and in rough weather it was harder than you would think or do on a normal practice.
Not a joke when you are spearing.