New AIDA rules: Impact on depth competitions?

[samdive]

The whole situation with regards to medics has always been desperately unclear (one set of rules said something about having a "fireman" present at all times!). I asked several members of the board for clarification and got various responses varying from yes, an EFR first aid instructor would do, to no, it had to be a fully qualified doctor. After a few years of running competitions, the minimum I would want now would be a qualified dive medic (a UK HSE qualification) - ideally you want an ER doctor with decompression experience.

At Saltfree we've used various levels for our competitions - once we paid a doctor, once we had a doctor who dived with us anyway and did it in exchange for a course, a friend who is an ER nurse, and a couple of times we have used an HSE Dive Medic (not a doctor, but with all the BLS skills needed for diving). We have our own O2 kit but not AED, I am not sure how we could use that safely in the wet environment in which we all operate anyway. To have to hire one for the next competition will be an added expense.

I don't want to be seeking to save money but just wish AIDA would clarify things - and also acknowledge the dramatically different access to state or other public healthcare dependent on where the comp is taking place. At Chepstow we can have a helicopter and paramedics arrive within 10 minutes and an ambulance possibly quicker, so if the "medics" on site only have basic life support skills and equipment that should be enough - up at the Blue Hole in Dahab, you're in quite a different situation. What you need also depends on whether or not you have scuba divers involved in the safety/video. If so, then you clearly need not just a medic who can resuscitate people, but one who understands decompression sickness too.

For sure, this section of the rules needs clarifying, and that should be done by a medical professional, not someone who happens to be on the board and knows a few medical terms.

I have also seen several cases where mouth to mouth was needed, luckily only one so far at Saltfree, and we had a doctor there on the day - it is terrifying for everyone concerned and that is the precise point at which you are suddenly very glad you raised the extra money for a qualified medic!

 

[efattah]

- In Audrey's case, the surface support failed. There were no paramedics or anything. She could have been (almost certainly) saved with proper equipment and personnel at the surface. Maybe Loic could have been saved as well.

In the cases of mouth-to-mouth after blackouts, I have witnessed several blackouts where the person just doesn't wake up, even after 3 minutes of unconsciousness. That's when you have no choice (BTW--I don't recommend waiting for 3 minutes, if after 30 seconds the person doesn't wake up, I would start mouth-to-mouth).

 

[bubbleless]

Great discussion so far, i completely agree that for sled diving, which is a whole different kettle of fish, comprehensive, all encompassing skills and equipment need to be on hand - ACLS at a bare minimum.

For the most part ( in my limited experience of a few years) i have only "attended" one person in respritory arrest having blacked out at -15m, and this was easily managed with out requiring too much effort. Most of the other "major" incidents ( thanks Chris!!) could have been easily managed by a calm and confident "first aider".

There can absolutely be no price put on the preservation of human life, but I feel that AIDA's move to state a minimum level of care being ACLS, is a bit OTT.

I recounted the experience I had to an ER doctor, where the diver i mentioned above who blacked out at -15m also suffered a pulmonary edema, he was horrified to learn that the diver wasn't intubated, and didnt believe that this course of treatment was not required.

The problem with "health professionals" that don't have any exposure to the sport - is that, like Frank alluded to is they are quick to bring out the airway management gear, intubate, push the drugs and all the kinds of things that in their ER rooms are essential in the first few minutes, but are not essential in recovering a freediver ( in general )

Yes - from what I understand, Audrey could still be with us if the right kind of attendance and treatment was available on site. But correct me if I am wrong, the old AIDA rules for World Record attempts were different than for competition ( with regards to some safety aspects), and this is potentially why there have been no fatalities in competition.

I hope AIDA clarifies this point at some stage, there maybe some disappointed freedivers around the world, if organisers cannot procure the level of medical attendance that AIDA is now demanding to run their comps.

Oh PS - why oh why do they still have "fireman" listed as a suitable person to be in attendance, after spending 3 years in the fire service I can warrant that firemen( here at least) only get training in comprehensive first aid, which is well below the ACLS standards AIDA are after.

 

[francisco]

Suffering a blackout from being stuck at 40 m in CW or 140 m in NL is in my opinion exactly the same. Equipment for safety and treatment should not be different for any depth disciplines.

Same lung damage, same water in the lungs and stomach, possibly same low levels in PpO2 ...

 

[francisco]

Just wanted to add one more thing :

Once you have your lungs FULL of water for a few minutes (1, 2, 3 ) it is extremely rare to have you back.

Maybe freedivers should start thinking of a system that would prevent water from entering the airways after blacking out. A strap of open cell neoprene sewed on the hood and stretched over the mouth keeping it closed..who knows. This would not prevent the oedema part but would simplify the task on the surface.

 

[Rik]

In all honestly, I doubt that ACLS would have saved Audrey's live.

She has spend a long time at extreme depth, a depth we know that can cause severe neurological DCS with one single freedive, just by spending one minute too long at these depth.

Even if we assume the unlikely case that an ACLS specialist was able to restore her airway (massive lung hemorage!), correct her severe hypoxia (loss of conciousnesss at 100m!), she still would have to survive neurological DCS, while being far form an decompression chamber.

However... we are not discussing no-limits, but regular depth competitions

It's my opnion that we don't need a physican who is an expert in managing hospital trauma's.

We do need a physican, who is an expert in dealing with
Diving and Sports medicine.

- Someone who do know the rules of our competition
- Someone who do know how, and when to treat an accident.
- Someone who can give advice after an incident if we are fit to dive

But also:
- Someone who knows about medication and their effect on diving
- Someone who we can discuss with if our prescribed medication is on the dopinglist.
- Someone who would ask about serious and not so serious health issues, without being afraid to be excluded from the competition.

These are the kind of requirements that would help making freediving safer, not just for accidents, but also to prevent them.

Just my 0,2 cents,

Rik

 

[Tony Babowicz]

Just wanted to add one more thing :

Once you have your lungs FULL of water for a few minutes (1, 2, 3 ) it is extremely rare to have you back.

Maybe freedivers should start thinking of a system that would prevent water from entering the airways after blacking out. A strap of open cell neoprene sewed on the hood and stretched over the mouth keeping it closed..who knows. This would not prevent the oedema part but would simplify the task on the surface.

I am not an expert by no means but I believe our body has its own system. Laryngospasm. I don't think it totally prevents water from entering, but a neoprene gag might not be comfortable to wear.

 

[efattah]

Keep in mind that Sefano Makula blacked at at 100m+ on a no-limits dive, and was saved by the scuba divers and resuscitated. And Fred Buyle had his no-limits accident--stuck at 100m with failed lift bag, waiting for the delayed counterballast--waiting for the blackout, and did blackout way deep and had DCS at the same time. Out of the hospital in 2 days. Now after his boat accident, he has come close to death many times!

 

[rxcnc2]

For sure, this section of the rules needs clarifying, and that should be done by a medical professional, not someone who happens to be on the board and knows a few medical terms.

Totally agree, waiting for that. As well as for comments from people that are organizing NOW the next deep competitions of 2009.