Recovery technique

[qai4321]

Hi guys, I have a query. In the case of a diver suffering a blackout and in particular experiencing laryngospasm below the surface. Is it possible to open the persons airway unintentionally by bringing the person up by holding the person by the jaw or neck from behind - there by allowing water into the lungs of the diver?

The recovery technique i was taught involved passing the arm below the subconscious divers arm and then hold the head between the hands, one hand on the head and one on the chin. But would this open the subconscious divers airway?

 

[azapa]

If the head is not supported it will probably flop back and the airways may then open.

You are almost there with your final description: put one hand behind the head (just above the nape of the neck) and the other, palm up under the chin with two extended fingers holding the mask in place and airways closed. Sort of lift them by their heads.

If there is too much weight to lift very easily this way you should have dropped yours and his weight belts already!

 

[fcallagy]

+1 on dropping the weight belts Azapa is a heavy bugger from depth.

 

[Rik]

qai4321, the method you describe seems to be the do-si-do method developed by Butch Hendrick. If you are positioned at the right side of the victim, you will put your right arm under water under the armpit of the right shoulder of the victim and put your right hand over the mouth and nose of the victim. You will use your left hand to hold the head between your hands.

In this position, you can maneuver the head independent from the body in different directions and securing a good grip on the victim during transport because your arm is in the armpit of the diver. You can also use this method to move the victim alongside if you want more space for finning.

The independent movement is important during the rescue dive, because it assist in securing the victim, having two points of leverage (armpit and head) and because you can tilt the head towards the sternum. The combination of tilting and closing the nose and mouth will protect the airway sufficiently for entering water.

The do-si-do isn't only excellent for offering protection of the airway, it can also be use to provide rescue breaths at the surface and during transport at the surface without repositioning your arms and losing contact with the diver.

To perform rescue breaths, you use your right hand to open the mouth (chin lift) and your left hand to pinch the nose to avoid escaping air. This maneuver will free the tongue and make it easier to perform rescue breaths.

Incorrect positioning of the neck and head during rescue breaths can cause the tongue to block the airway, giving the impression that the victim has an laryngospasm.

Therefore, always check the head positioning when giving rescue breaths turns out to be difficult.

 

[qai4321]

Good stuff guys. Thanks Rik, I realize now that by having my hand on the chin, mouth and nose, I can be sure the diver isnt ingesting water. I did a CPR course once and learned the importance of opening the airway before hand. I was surprised that even at 3star Aida they do not mention the correct way to do CPR...considering the importance of it.

 

[Rik]

Most AIDA instructors are not qualified to give CPR courses and most CPR courses doesn't explain the anatomy sufficiently to explain the importance of opening the airway.

I am curious if it would be possible to explain most laryngospasm experiences with bad resuscitation techniques. Does anyone have some video's to share where people demonstrate their resuscitation technique on an unconscious diver?

 

[Dartfisher]

I've never given rescue breaths or CPR to a diver in the water but as a firefighter, I practice these techniques and provide them to patients often. If caught in time, most divers experiencing laryngospasm will only need a couple breaths. During a laryngospasm, hyperextending the head backwards should open the airway. If the diver is unconcious for a long period of time, the heart will stop and CPR should be given.
Bad techniques usually result from not opening the airway enough and not providing a good seal between the rescuer's mouth(or bag-valve-mask) and the diver's mouth.

 

[qai4321]

Im curious, over the nose or over the mouth... what are the pros and cons of each?

 

[Dartfisher]

I'm thinking over the mouth. Hopefully the diver still has a mask on. If the diver no longer has a mask, I would try pinching the nose while covering the mouth.

 

[Rik]

CPR over the mouth is preferred due less resistance larger volume. The nose can be used when the mouth is unusable due trauma. Both techniques require some exercise. Methods like the chin-lift to open the airway aren't that difficult, but you need to train them with a qualified instructor, so you know how to use them in an actual emergency.

When performing rescue breaths trough the mouth, you need to close the nose.

An alternative is using a pocket mask that contains both the nose and the mouth. Nevertheless, it does require some exercise to use the pocket mask effectively to avoid air leakage while performing CPR.

 

[Dartfisher]

I'm sorry, I thought you were asking about where to place the hand while bringing the diver to the surface.
I have a mouth to mask adjunct that I carry with me that encompasses the mouth and nose.

 

[whiteminiman]

CPR over the mouth is preferred due less resistance larger volume. The nose can be used when the mouth is unusable due trauma. Both techniques require some exercise. Methods like the chin-lift to open the airway aren't that difficult, but you need to train them with a qualified instructor, so you know how to use them in an actual emergency.

When performing rescue breaths trough the mouth, you need to close the nose.

Absolutely correct. However, mouth to mouth is very very difficult (if not impossible) to do in the water. You need one hand to pinch the nose, and one hand to tilt the chin... so what are you holding onto whilst doing that? The casualty sinks!

Mouth to nose is the preferred (by lifeguard services worldwide) technique for performing rescue breathing in the water. With one arm you hold onto a floating object (like a boat) and rest the head of the casualty on that arm. You can then use the other hand to tilt the casualty's chin back, and seal their mouth at the same time.

Have a look here:

Statements on In Water Resuscitation | International Life Saving Federation

Regards, WMM

 

[Rik]

Well, there is where the earlier mentioned DO-SI-DO method helps, because your arm supports the victim. But, mouth to mouth can be difficult, especially if there are surface conditions with waves or winds.

Alternatives are mouth to nose or snorkel to mouth, but you needs to be trained for both methods to be able to do them succesfully. Both alternative methods and the DOSIDO methods are not part of a basic CPR course, en often minimally reviewed during a rescue diver or freediver course.

This won't be a big issue during most competitions, because these will have sufficient surface support and easy access to professional health care. This is however different during recreational dives and competitive dive training. In my opinion, you should discuss this issue with your local freedive instructor and discuss to train this on a regular basis.

 

[qai4321]

Nice link WMM

Q

 

[fcallagy]

Mask should be the first thing you take off a recovered freediver.

 

[haughki]

...In the case of a diver suffering a blackout and in particular experiencing laryngospasm below the surface. Is it possible to open the persons airway unintentionally by bringing the person up by holding the person by the jaw or neck from behind - there by allowing water into the lungs of the diver?

I'm honestly a little confused by what you're describing here, esp. "by holding the person by the jaw or neck from behind". I think I know what you're talking about (I've seen a rescue technique like this), but can you explain this in a little more detail?

If you are meeting or retrieving a blacked out diver at depth, I think you should do your best to 1) protect/close the airway and 2) keep the head in a neutral position (so that you protect/close the airway). One way to do this is to get one hand grabbing the front of the face (palm slightly under the chin, fingers on the mask), and the other hand palming the back of the head. In this way, you would swim the diver up with his/her head in between your hands, and your body plane perpendicular to his/her body plane (i.e., with one of his/her arms facing the front of your chest). This puts you in a good position, once you surface, to do the do-si-do hookup (that folks mention above) and start surface rescue.

In terms of laryngospasm, I would suggest that we don't know _that_ much, only that it sometimes happens, sometimes not, and varies a lot in degree and length (of time that it holds). I suppose it's possible to inadvertently tilt a diver's airway in such a way that it would (possibly) open up a laryngospasm to some degree. But this seems like fairly wild speculation, and in any case, it seems reasonable to try and keep the head in a neutral position when retrieving a blacked out diver from depth (to better protect the airway). It sounds like the method you describe ("by holding the person by the jaw or neck from behind") may not keep a neutral head position. That said, if you're describing the method I think you are, there may be some other advantages to that method (which we're not really talking about. Maybe someone else can clarify on that).

My understanding is that laryngospasm tends to be much more of an issue when you're trying to open up an airway and get a breath in. Blowing hard across the diver's eyes, putting positive pressure on the laryngospasm with one or two strong rescue breaths, and time passing are the things I've heard about that can free a spasmed larynx.

Hawkeye Parker
San Francisco, CA