New AIDA rules: Impact on depth competitions?

[Phil C]

In NZ we take safety seriously but we are concerned about the requirements in Section 4.15 relating to the following requirements:

"In depth disciplines the presence of a professional healthcare provider that is capable of providing advanced cardiac life support is mandatory .... must be supported with the appropriate equipment to do so."

Have a look at the link to see definition of ACLS:
[ame="http://en.wikipedia.org/wiki/Advanced_cardiac_life_support"]http://en.wikipedia.org/wiki/Advanced_cardiac_life_support[/ame]

Here in NZ we operate with a trained medic who has been with us for years and understands freediving risks and treatment, but would not meet the above requirements.

Typically our entry fees are less than $50 US, for this we can operate a safe competition. Compliance with the proposed regulation will likely raise our entry fees tenfold and significantly reduce participation. Also it will mean that a "professional healthcare provider" will be dealing with freediving incidents, possibly something they are less experienced/equipped to do than our medic.

We understand that competition in Litigious North America will have stringent demands placed on them by insurers and organisers. But this simply does not apply here in NZ. We have a state run, no blame, anti litigous, accident compensation corporation.

Are there any other National AIDA Organisations out there who will face the same problems under the proposed regs?

 

[Mullins]

I'm pretty sure fees of $1k per diver would rule out depth competitions in NZ. Or rather, we'd have to do them without the blessing of AIDA.

 

[trux]

I do not think it would raise the costs so dramatically. Professionals (medical doctors) with oxygen and defibrilator are mandatory for every competition (including pool disciplines) here in France since a long time, and the starting fees are usually around 20€. Well, I realize doctors may charge more in other countries, but I wonder if it really reaches 4 or 5 digits amount as you seem to be fearing. Have you checked with some local sport physician and do you know what he'd charge?

 

[Mullins]

Well we could get a textbook, car battery and some wiring for $200!

 

[trux]

I do not think the rules tell you have to own (or build) the equipment. Hiring a doctor who has it is sufficient And most sport or emergency physicians do have their own ACLS. Don't tell me they charge $10k for half a day in NZ.

 

[Jon]

Well we could get a textbook, car battery and some wiring for $200!

Didn't I see James Bond do that in Casino Royal?

 

[bubbleless]

Well we could get a textbook, car battery and some wiring for $200!

That is brilliant Kiwi Ingenuity!!!

 

[Stavros]

Hi Guys,
I am sorry to burst your bubble but if we take words literally ACLS is not a defibrillator or any other short of life support a sport physician uses in his normal days work.

After checking with my better half (Panagiota Balanou) who is a Medical Doctor (Trauma Orthopedic) and has worked in ER (as well as being an AIDA judge and athlete) I have been informed the ACLS is a mobile unit of equipment used to maintain breathing and cardiac operation of a patient which is normally used in ERs and is definately not a AED (automatic difibrilator) or a ventilation system but something far larger - far more complicated and something that has never being used in any national or international competition I have been to in the last 4 years.

My personal opinion is that whoever put that in the regulations just wanted to use a big fancy word to describe something simple (and messed up the description big time) OR was someone thinking mainly of the comp situation in the US (which I highly doubt)

In the end if voted this will be just another of these things that are in the rules but are never enforced...(if enforced all depth competitions will be cancelled by the judges or will have a 1000euro entry fee and that will be the end of that)

Unfortunately the new rules are riddled with little things like that ... like the 1,5m tie-yourself-in-a-knot lanyard...


Don't know... not happy

Cheers Stav

 

[bubbleless]

Stravos, you have hit the nail on the head. the wikipedia link that philc has provided explains that ACLS includes the ability to bring out the big guns so to speak. Having a doctor at a comp with a AED and O2 cylinder as mentioned as being used in the french comps, is not ACLS, it is at best BLS.

I think this particular point needs to be clarified if it is going to be included in these new rules ( as with many others ).

The reason we here in NZ are concerned about it is that to attain this type of qualification in NZ is expensive, and to have this type of qualified person on site is also expensive - indicative prices are anywhere between $1-2k per day, now we might have some kick arse divers here, but we dont have a large competitive freediving community to offset these costs ( maybe a dozen, and it would be rare for all of them to be in one comp together!!), so this cost is borne directly by them by way of entry fees to comps. Other smaller nationals must also have this same issue.

Another issue as i see it is ACLS is different from nation to nation. What we have here in NZ as a full ACLS qualification, is vastly different to what it is in the UK and the states. So when AIDA rules stipulate that someone needs to be able to provide ACLS and have the gear to do it, is that as per the standard in the country of the event, the wikipedia definition or the online ACLS certification you can get???

If AIDA deems ACLS to be an 02 cylinder and AED, then AIDA needs to stipulate that in their rules.

 

[Aber]

Have there been any incidents in constant weight competitions that justifies these kind of regulations?

 

[fpernett]

Advanced Cardiac Life Support (ACLS) is more than a machine, is all included in Basic Life Suport (ABC), plus Tracheal intubation, availability and knowledge on the use of drugs like Adrenalin, Atropine, Bicarbonate, Amiodarone, Lidocaine, etc, etc, plus the use of Cardioversion and Defibrillation plus use of external or intravenous cardiac pace makers. So it's the use of a lot of resources by a highly skilled proffessional to provide CPR at a maximum level.

Check AHA Protocols

In my opinion the level of complexity depends on the risk of a serious black-out, for example if all this resources had been available in the main boat of Audrey's record attempt, she possibly had a chance to survive. But if you are in a small national competition with a maximal depth of 30 meters, maybe that's over-the-top.
Must of our accidents resolve with proper BLS, but who knows where to draw the line?... I don't.
Safety procedures must be focused on fast recovery of the injured athlete, because time is critical.
I would say that ACLS should be desirable, but not mandatory in a safe wise organized event.

 

[Stavros]

Hi fpernett - most depth competition black outs (all I am aware of apart from one in the last 4 years - both at a national and world level) do not ever get to the stage of requiring BLS - just maintaining the airways out of the water is enough...

That level of medical support has never been called for except as you mentioned in the two fatal accidents we have had in No-Limits.

But to have the cost of all that equipment and personnel on every depth competition (Even on every high level depth competition) would be prohibitive.

So it comes down to do you do what is the safest possible option or what is the safest realistically feasible option.

Again I would like to say that I have a strong feeling that whoever put the term ACLS in the rules did not really understand what ACLS means (maybe confused it with an AED)

Stavros

 

[fpernett]

Hi fpernett - most depth competition black outs (all I am aware of apart from one in the last 4 years - both at a national and world level) do not ever get to the stage of requiring BLS - just maintaining the airways out of the water is enough...
Stavros

Hi Stavros

I don't have the same feeling. I had to do mouth to mouth respiration twice.
If we go with this reasoning why we use lanyards and counterweigth systems if none has to use it. Safety is about to be prepared, something like "hoping for the best, but expecting the worst".

I'm living in a poor income country and for the first (and only) national championship I had everything needed for advanced reanimation. We didn't use it at all!!. So, I don't think that all this support is essential in all competitions, but if you can have it. Better.
Expertise in basic reanimation seems to me an essential at every depth competion

 

[chrismar]

Hi Stavros

I don't have the same feeling. I had to do mouth to mouth respiration twice.
If we go with this reasoning why we use lanyards and counterweigth systems if none has to use it. Safety is about to be prepared, something like "hoping for the best, but expecting the worst".

I'm living in a poor income country and for the first (and only) national championship I had everything needed for advanced reanimation. We didn't use it at all!!. So, I don't think that all this support is essential in all competitions, but if you can have it. Better.
Expertise in basic reanimation seems to me an essential at every depth competion

Interesting to hear that you had to do recovery breaths. Could you elaborate on the situations?

As for your second point, the ACLS referred to in the original post is talking about isolating & drying the victim, hooking them up to an ECG and based on the specific cardiac responses administering treatment. That could be manual defib, injecting atropine, epinephrine (adrenaline), modulated shocks and so on.

Our usual medic is an ex-paramedic with emergency life support certification. She is also a freediver (we're so proud of you!) and partner of a top athlete. She is also now no longer qualified enough to do the job if the rule change takes place. Unless you are ACLS certified too, neither will you be.

Remember: This is not a case of providing a healthcare provider & an autodefib. This is closer to providing the cardiac unit at an ER. How much do you think hiring just the equipment is?

 

[efattah]

I've witnessed at least three blackouts which required mouth-to-mouth.

Also, there is a rumour that Simoni from New Caledonia went into cardiac arrest after a BO @ 18m in the 1998 world chamionship (-58m dive).

 

[Phil C]

One of the clauses will exclude our medic regardless of the training and equipment that we throw at her. She is not currently employed in a medical capacity.

 

[fpernett]

Interesting to hear that you had to do recovery breaths. Could you elaborate on the situations?

As for your second point, the ACLS referred to in the original post is talking about isolating & drying the victim, hooking them up to an ECG and based on the specific cardiac responses administering treatment. That could be manual defib, injecting atropine, epinephrine (adrenaline), modulated shocks and so on.

Our usual medic is an ex-paramedic with emergency life support certification. She is also a freediver (we're so proud of you!) and partner of a top athlete. She is also now no longer qualified enough to do the job if the rule change takes place. Unless you are ACLS certified too, neither will you be.

Remember: This is not a case of providing a healthcare provider & an autodefib. This is closer to providing the cardiac unit at an ER. How much do you think hiring just the equipment is?

Hi Chris
I know personally Joy and Kerian (great couple BTW)
I´m not here to discuss my certifications. As I wrote in my first post, a full support will be DESIRABLE, but not MANDATORY. I agree that we usually don´t need such level of complexity. But, if you can have it, it's better.
Just remember Audrey and Loic. That's the point, you don't know when you're going to need it. When you are facing other people death, budget is not an issue.
For me is easy to say this, because of my specialization I have access at no cost to full equipment, and that´s why I demanded to have one at our national competition.
I think that's too much for constant weight competitions, but not for Variable and No Limits attempts.

 

[chrismar]

Hi Chris
I know personally Joy and Kerian (great couple BTW)
I´m not here to discuss my certifications. As I wrote in my first post, a full support will be DESIRABLE, but not MANDATORY. I agree that we usually don´t need such level of complexity. But, if you can have it, it's better.
Just remember Audrey and Loic. That's the point, you don't know when you're going to need it. When you are facing other people death, budget is not an issue.
For me is easy to say this, because of my specialization I have access at no cost to full equipment, and that´s why I demanded to have one at our national competition.
I think that's too much for constant weight competitions, but not for Variable and No Limits attempts.

Yes, I agree with you. I do remember Audrey and Loic, but I also remember they were, as you say, doing no limits. It is such a different beast that it's hard to compare against anything else. In both cases too, it was the other safety mechansms that failed the divers, NOT surface support. I'm not really arguing against you, just trying to push for reconsideration of this rule.

ps. I've given Joy a bit of a work in the last couple of comps (unfortunately!) and can vouch for her abilities as a medic! I would prefer to have her there than an ACLS professional that didn't know about the sport.

 

[Stavros]

Eric,
I have a question regarding the cases were mouth to mouth was needed - are we talking about cases of respiratory arrest or cases of over eager safety divers giving mouth to mouth were it was not really needed? Cause I have seen my fare share of the later in comps which I always find counterproductive to the BO athlete snapping out of it fast.

Cheers Stavros

 

[fpernett]

Yes, I agree with you. I do remember Audrey and Loic, but I also remember they were, as you say, doing no limits. It is such a different beast that it's hard to compare against anything else. In both cases too, it was the other safety mechansms that failed the divers, NOT surface support. I'm not really arguing against you, just trying to push for reconsideration of this rule.

ps. I've given Joy a bit of a work in the last couple of comps (unfortunately!) and can vouch for her abilities as a medic! I would prefer to have her there than an ACLS professional that didn't know about the sport.

We're finally getting the point. I think most of us agree that for Non-Sled disciplines Advanced Cardiac Life Support could be too much. As you mentioned, Loic and Audrey accidents where due to fail of safety system, BUT if a full reanimation was offered immediately, the final story could be different. Most of the drowning victims are in respiratory arrest, and hypothermic, and those are "easy" conditions to revert if things are done properly.
You're right about full trained professionals that don't know anything about the sport. Long time ago my brother organized a CWT competition, as I was participating, I asked a colleague to be in place. A Venezuelan freediver suffered a BO, and if I don´t stop him, he was ready to intubate the guy!!.

The 2 times I had to do mouth-to-mouth respiration where to my brother after deep black-outs, when he was training deep statics.