Question about getting a blackoutee to the surface.

[DeepThought]

Saw those two pictures on Pete's Dahab photo page::
Demonstrated underwater rescue Style 1:

Demonstrated underwater rescue Style 2:

Was wondering what are the pro and cons for those different methods, what other good methods are there (pictures if anyone got) and what about monofinners...

A few more questions (I have no expirience with underwater blackouts so far):
- How likely it is that a BO'ed person will get water in the lungs (even after exhaling air but as long as the diver is on the way up)?
- How likely it is that if such a thing happens the safety diver will grab the blackoutee before then? (some show distress signals, some don't so I'm asking about how long after a BO it is likely to happen)
- How likely it is that this kind of mouth-block would actually work preventing that?
- Do you think sealing the diver's mouth while going up takes more time than just getting the diver to the surface? (more encumbered swimming, getting in the right position/grab) How much more? Has this been tested by anyone?
- Since the mouth-block is actually a jaw block, is there any risk to the neck? how about toungue?

The question behind all of this is:
Getting a blackoutee to breathe ASAP means faster/easier/more success in recovery and less/no brain damage (I don't hold to that 'damage occurs X minutes after blackout' paradigm - http://forums.deeperblue.net/561588-post5.html - was posted about pool safety). So basically I am asking if doing the mouth-block is the best way and if so then which way.

 

[Longfins]

My spider sense is tingling that this may erupt into THIS-versus-THAT thread, so I think I should comment first that the two pictures should be regarded as starting points in the learning process. I have been taught to perform UW rescue one way and am proficient at it, and for the first time I saw another method being taught. Which way is better? I don't know until I've had some practice with my crew. On that I think most everyone has been taught one 'best' technique. That's also why I labeled the photos as 'styles' instead of 'method': If you are proficient at your technique, it should make little difference time-wise how the blackout-ee reaches the surface.

Having said that, who here uses what style? How quickly can you execute it? Mono or Bifins? How often do you practice it? (Me: Style 1*, within 2-3 seconds max I'm on my way, both kinds of fins, average twice a year)

Overall, I think blocking the mouth is good (common in both techniques) as it tries to minimize the consequences of the worst-case scenario (terminal gasp / water inhalation) that happens some minutes after the blackout.

As Michael said, if there are other methods / styles, please add to our knowledge and discussion.

Peter S.

* I've renamed the photos so it's more neutral.

 

[naiad]

I think it is important to block the mouth. I don't know how likely it is for a blackoutee to inhale water, or after how long would it happen, but I heard that it happened recently in a competition. Preventing the blackoutee/samba-doer from inhaling water is very important.

Another question I thought of recently: if someone is doing dynamic without a full mask or noseclip, and they BO on the bottom of the deep end of the pool, is it important for the rescuer to cover their mouth and nose while carrying them to the surface?

I thought of this because we were doing practice rescues in the pool, and I was being 'rescued' from the deep end. The rescuer turned me on my back on the way to the surface, and I had to exhale to avoid getting water in my nose. This wasn't a problem because it was only a practice rescue and I was conscious, but in a real-life scenario I would probably have inhaled a small amount of water. This is because if there is water in my nose and I am turned on my back on the surface, the only place it can go is in my airway. :waterwork

Also, that's the first time I've seen the word 'blackoutee'! Makes it sound like a career option!

Lucia

 

[immerlustig]

here is my opinion on that:

in case you don't feel like reading the whole post scroll down to where it says 'conclusion'.


- How likely it is that a BO'ed person will get water in the lungs (even after exhaling air but as long as the diver is on the way up)?

one thing that can happen underwater is a laryngospams which can be triggered by water entering the airways (accidentally sucking in water) or by panicking. i am not aware of any studies which say a laryngospasm will happen every time a diver bo's under water. therefore there is a possibility that the diver gets water into his lungs. also, the laryngospasm will release after some time with the same result (drowning/secondary drowning).


- How likely it is that if such a thing happens the safety diver will grab the blackoutee before then? (some show distress signals, some don't so I'm asking about how long after a BO it is likely to happen)

not sure what you mean here. usually there are quite a few signs of an impending bo. realising these is crucial in order to react quickly. for example: slowed or accelerated kicking, uneven kicking rhythm, seemingly tense body, looking to surface, facial expression, uncontrolled exhalation, etc. ideally the spotter knows the divers usual behaviour/style on ascent which makes it easier to detect anything "wrong".


- How likely it is that this kind of mouth-block would actually work preventing that?

the mouthblock is in our experience the easiest and most efficient way of getting a diver to the surface for a few reasons:
1. it is easy to grab the diver from any angle
2. the spotter does not have to turn the diver around to get into a position to the side or behind the bo’d diver
3. the mouthblock is very easy to apply and properly seals off the airways under water.
4. works easily with/without mask/noseclip
5. reduces chances of water in the mouth/throat which will lead to major problems on the surface


- Do you think sealing the diver's mouth while going up takes more time than just getting the diver to the surface? (more encumbered swimming, getting in the right position/grab) How much more? Has this been tested by anyone?

timewise i find the mouthblock faster or at least as fast as any other method i have tried. and yes, it is being tested/practised regularly. for the rest see above.


- Since the mouth-block is actually a jaw block, is there any risk to the neck? how about tongue?
we do not apply the 'jaw-block'. the divers head is effectively 'clamped' with one hand on the back of the head and the other hand in the face (covering the mouth). there is no strain on the neck since the diver is neutral or positively buoyant anyway.


conclusion:

it seems to me that the 'mouth-block' ascent is the easiest, safest and most efficient method (i am aware of) for rescuing a bo'd diver underwater. the biggest advantage over other methods is the fact that, if done properly and quickly, there will be no water in the victims mouth and throat. if that would be the case there is no way to effectively remove that water from the divers mouth (since you are floating on the surface) to allow spontaneous breathing. water in the mouth can delay recovery and delay the release of a possible laryngospasm. i feel that the first actions of the safety diver are decisive in the outcome of a bo. any possible complications, however rare they are, will lead to major (!) problems which only very, very few people are actually trained to handle. so practising rescues regularly is important.

just my 2 cents,

roland

p.s. if someone could send me a pm how to insert quotes in a post i'd very much appreciate it

 

[samdive]

Firstly - I need to correct Peter on labelling one of the methods "aida style" - its not "aida style" its my style..... There is no AIDA style precisely because the way you lift someone will depend on a load of factors, how deep you are, how bouyant you both are, bi fins/monofins, relative size of the victim and rescuer, visibility of the water.. (if you drop them are you likely to ever see them again?), surface arrangements and what comes naturally to you to do in an emergency....

I teach people that basically you need to get the person to the top as quick as you can without dropping them, and if at all possible, hold their mouth shut while you do so. If you can also arrive on the surface in a position where you are going to easily be able to keep them afloat, hold their airway open and check for breathing - even better. Thats why I choose to lift from behind. They end up lying back on your shoulder when you hit the surface. It also makes it much easier to rescue with a monofin on (in my opinion)

Yup this is going to turn into a juicy discussion.. and I knew it would the minute I saw the photos on Peters site!!

 

[Mr. X]

Release the belt?

RELEASE THE WEIGHT BELT??
I notice in several of the rescue images above & in links, the victim & rescuer are both still wearing their weight belts...seems like it would make things a lot easier if the victims weight belt were released or both belts were released. [I mention this because a friend described a recent scuba double fatality where one diver died attempting to rescue his partner. Failure to release either or both weight belts was a factor/anomaly].

 

[Mr. X]

Heimlich to clear the airways?

HEIMLICH TO CLEAR AIRWAYS?
Any Heimlich advocates out there? Ref: Using the Heimlich Maneuver to clear water from the airways? This is sometimes used in the USA before starting resucitation (see this link for the paper & the one above for instructions).

'The Heimlich Maneuver for DROWNING "You can't get air into the lungs until you get the water out!" '

"CONCLUSIONS
The scientific facts concerning drowning and resuscitation, including published case reports, prove that drowning victims die when their lungs fill with water. Air cannot get into water-filled lungs. Heimlich maneuvers remove the water from the lungs in four to six seconds. Pressing upward on the diaphragm jump-starts breathing. Many drowning victims have been saved by rescuers performing the Heimlich maneuver, even after CPR failed. The Heimlich maneuver should be the first step in resuscitating a drowning victim, followed by CPR, if necessary."

[Also, see self-Heimlich, infant Heimlich & Heimlich for severe Asthma Attacks...it definitely works for choking, I had to use it on a friend once (dry bread jammed in throat). Also had to deal with a choking infant in a high chair -- the non-Heimlich back slapping technique often taught as first aid did *not* work (Heimlich recommends against this, despite normal first aid practice) -- ended up putting my fingers down the childs throat to clear it...life or death, no other choice (he lived). Turned out to be a soft, slippery piece of cucumber sealing his throat off completely.]

 

[Longfins]

Mr. X,

Both the photos show the rescues in demonstration of technique only. Dropping the weight belt where we were would have been made things harder because the bottom was 80m away! The question of whether dropping the weight belt would make sense depends on if the rescuer felt he/she and/or the victim was too negatively buoyant and could justify the time needed to do so. More likely than not the answer is yes, release the weight belt. But if diver blacked out in the buoyant zone, the rescuer is strong, and the distance to the surface is short, there's no reason to drop it every single time.

And as far as the Heimlich maneuver, If there is land or a platform immediately nearby, great. But I don't know how to perform it in open water while keeping the victim's airway out of the water at the same time. Do you?

Also, I've renamed the photos to just Style #1 and #2 (Michael, note which is which.) These were just supposed to be vacation pictures!

Peter S.

 

[ramstam]

During the times I have practiced this I have noticed that it is comfortable to place a hand to hold the mouth shut and mask on, during the swim to the surface. On the other hand, I have had people drag me to the surface by my face and it doesn't feel very easy on the neck or jaw...if I were BO'd I guess I wouldn't notice.

I'm not sure how I would handle in water rescue breathing AND be able to
tow the person while wearing a monofin. I guess it is all what you are used to.

 

[Erik]

Remember that a freediver in a 3mm or 5mm suit might be wearing only 1 to 5 kilos, as opposed to a scuba diver: single aluminum tank, salt water, drysuit...12 to 20 kilos! In the case of scubadivers, there's no question of ditching his belt. With freedivers, it's variable.
Peace,
Erik Y.

 

[Mr. X]

...And as far as the Heimlich maneuver, If there is land or a platform immediately nearby, great. But I don't know how to perform it in open water while keeping the victim's airway out of the water at the same time. Do you?

No I don't know if it is possible to perform it in the water. It seems like it should be (it is basically a hug with force applied under the diaphragm) if the pair are buoyant -- but I have never tried it. [They reckon resuscitation will sometimes/often fail if water is trapped in the airways because when rescuers try forcing air into the victim, the body detects the water and reacts to keep it out of the lungs. Apparently drowning victims often do not have water in their lungs -- the body has reacted to keep it out.]

 

[Mr. X]

Remember that a freediver in a 3mm or 5mm suit might be wearing only 1 to 5 kilos, as opposed to a scuba diver: single aluminum tank, salt water, drysuit...12 to 20 kilos! In the case of scubadivers, there's no question of ditching his belt. With freedivers, it's variable.
Peace,
Erik Y.

I notice a lot of spearos carrying more than that (presumably for aspetto?) - ~10 Kg / 22-24lb. With a 5mm suit, 3 Kg doesn't cut it for relatively shallow aspetto spearing.

 

[immerlustig]

hi all,

@samdive

It sounds to me as if you see a rescue more like a random affair rather than a rehearsed reply to a standard problem. Maybe I misunderstand something?

There is no AIDA style precisely because the way you lift someone will depend on a load of factors…

That almost implies that one has to learn a large number of different rescue techniques to accommodate all those varieties. The more complicated a technique becomes the less likely it will work. Especially when considering the sad fact that most freedivers hardly ever practice rescues. If there is a possibility to drop a bo’d diver, or if the safety diver has problems when using a mono, then the technique that is applied is surely inefficient. Can an efficient technique be based on improvisation?

…you need to get the person to the top as quick as you can without dropping them, and if at all possible, hold their mouth shut while you do so. If you can also arrive on the surface in a position where you are going to easily be able to keep them afloat, hold their airway open and check for breathing - even better.

In a rescue scenario I do not believe there is a place for “if possible” or “if you can…even better”. Water in a bo’d divers lungs can lead to drowning or secondary drowning. This is a potentially life threatening situation. Water in the mouth/throat can delay recovery from the bo which increases chances of brain damage. Therefore the rescuer is better SURE of what and how he/she is doing things and aware of their responsibilities.

An efficient and rehearsed way of getting a bo’d diver to the surface will dramatically increase chances of a quick recovery of the victim (i.e. spontaneous breathing). If complications are developing that make CPR necessary you are pretty much fucked. How many people have a proper platform right at their dive site or a proper rescue plan beyond bringing the victim to the surface?


@mr x.

the topic started with the question whether water can enter a bo'd divers lungs during ascent. regarding the buoyancy issue, spotting at 15m max means both divers are pretty much neutral. the deepest i practise rescues is 20m and even from there the strain on the neck is minimal. of course, i am not yanking on the guy. dropping the weightbelt is surely something that needs to be considered then.
also, if a diver needs a safety diver to meet him at 20m because he feels a real chance of blacking out at that depth he most certainly is way past his capabilities and should rather limit the depth somewhat.

during all practice we never found the heimlich maneuver to work reliably with both divers (rescuer and victim) floating on the surface. it's just too difficult to keep the victims head out of the water (even without weightbelts on and in pool-like conditions). i'd rather put priority on a fast evacuation to a platform or shore.

any comments on that?

Cheers,

Roland

 

[Mr. X]

...during all my practice we never found the heimlich maneuver to work reliably with both divers (rescuer and victim) floating on the surface. it's just too difficult to keep the victims head out of the water (even without weightbelts on and in pool-like conditions). i'd rather put priority on a fast evacuation to a platform or shore.

Thanks for the info. -- that was what I was looking for. [Re. water entering the lungs, as mentioned above, I believe the body normally prevents this (by closing the larynx)-- but it would be good to have a physician or similar comment on that. I am not a physician, nor have I played one in a television soap opera.]

 

[fpernett]

Re: Heimlich to clear the airways?

The scientific facts concerning drowning and resuscitation, including published case reports, prove that drowning victims die when their lungs fill with water. Air cannot get into water-filled lungs. Heimlich maneuvers remove the water from the lungs in four to six seconds. Pressing upward on the diaphragm jump-starts breathing. Many drowning victims have been saved by rescuers performing the Heimlich maneuver, even after CPR failed. The Heimlich maneuver should be the first step in resuscitating a drowning victim, followed by CPR, if necessary."[/COLOR]

[Also, see self-Heimlich, infant Heimlich & Heimlich for severe Asthma Attacks...it definitely works for choking, I had to use it on a friend once (dry bread jammed in throat). Also had to deal with a choking infant in a high chair -- the non-Heimlich back slapping technique often taught as first aid did *not* work (Heimlich recommends against this, despite normal first aid practice) -- ended up putting my fingers down the childs throat to clear it...life or death, no other choice (he lived). Turned out to be a soft, slippery piece of cucumber sealing his throat off completely.]

As was mentioned before, the idea of keeping the mouth closed, is to avoid water to enter the airway. Because the main problem is not the water in the upper airways, but the water in the alveoli (where it has different effects depending if it's fresh or salt water). The laryngospasm is a "protective" reflex, that occurs in around 1/3 of the near-drowning victims, but this reflex can cause dry pulmonary edema when the victim try to breath against a closed glottis. 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

Besides, the laryngospasm is not there for a long time, after severe hypoxemia the muscle relax and laryngospasm decline.

So, my opinion is, that it's better to avoid any amount of water in the airway and keeping the mouth shut (the victim's mouth ) is the most practical way, and it's important also to keep the mask or nose clip in place to avoid that the water enters through the nose. And the best way to become efficient is by practicing it frequently. The question about the belts depend on the situation, if you are rescuing a huge victim, from 20 meters, I'll drop the victim weight belt. Once I had to recover a friend, not so heavy from 23 meters, who was going down, it took a lot of effort (I didn't ditch any belt). So, when you are facing a rescue, you should think in advance of the problems you should solve during this. That's way I advocate for the practice, because you have to act rapidly, and there is no time for long thinking at the moment

 

[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]

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).

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).

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]

Re: Heimlich to clear the airways?

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]

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

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]

Are you a hugger or a kisser?

...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?!?:hmm ...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/articles/23heimlich_controversy.html
The case against (including death of a 10 year old boy): http://lfsv2.securesites.net/vboard/showthread.php?threadid=124&highlight=Heimlich
The case against - 2000 Red Cross and Ellis & Associates change away: http://lfsv2.securesites.net/vboard/showthread.php?threadid=133&highlight=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) .