Recovering An Unconscious Diver From Depth

[Frank Griga]

Hi Lads,

Is there any recommendation for recovering an unconscious diver from depth (open water) where deco obligation took place? To make it easier and avoid confusion let say a 70m dive with 30 minutes bottom time where:

A) diver passed out in 5th minute since submerged

B) diver passed out in 25th minute since submerged

Would you take the risk and escort the body all the way up in both cases?
Would you send the body up feet first (sounds crazy to me)?

I was just wondering what would be the best approach.
There is some basic info in the following document. http://www.gue.com/files/Accident_Ma...Strategies.pdf

Would that work in those cases too?

All the best,
Frank

[david_1]

I thought if your deco was long the only option would be to send them up a dsmb line with yellow and red bags sent up first.... ?

[davetheshoeman]

G'day All,

It will be interesting to hear if anyone has actually made this decision. Please if anyone has actually ommitted large amounts of deco to assist a buddy i think there would be many people interested to hear about it if you are comfortable in posting it here.

Personally, I think the GUE reference sited says it all. It is worth the risk and you are, as the rescuer, are able to 'redo' ommited deco or go to the chamber. I don't think I could just leave somebody. Luckily I have never had tro make that decision.

nb: this is one of those threads that could get nasty so I hope that my comment have not caused offence.

regards
Dave

[LCF]

Not speaking as someone who has done any mandatory decompression diving, or rescue any unconscious divers, but speaking as an ER doc:

The first thing I would do is assess the state of the ill diver. If someone is unresponsive but breathing, the differential diagnosis of the CAUSE of the state is quite different from that of someone who is unresponsive and not breathing. The latter implies much worse physiologic derangement and a much poorer prognosis, especially if the change is sudden. The diver who is unresponsive but breathing may be severely narced, may have had a small and unnoticed seizure, may be diabetic and hypoglycemic (and didn't tell you), may be severely hypercarbic, may have taken something before the dive. Global depression of consciousness implies a systemic cause or a really severe central nervous system cause (aneurysm rupture, for example). But if the person is breathing, you have time, but maybe not infinite time.

In that case, getting the person expeditiously but not ballistically to the surface would be a good idea, and shortening deco is probably reasonable, as it is likely the person's problem is treatable and they may recover. How much to shorten the deco would depend on how deep you had been and for how long. Taking the two of you to the surface and arriving there coughing up red foam is not productive. And the diver is breathing, so one hopes progressive central nervous system damage is not being done.

If the unresponsive diver is not breathing, you are both in a world of hurt. As I have said elsewhere, breathing resides deep in the brainstem, and is so basic a reflex that the absence of breathing effort (apnea) was used as evidence of brain death before we had EEGs and brain scans. An unconscious diver who is not breathing, and who does not shortly begin to attempt to breathe (as, after a seizure, you can have a brief period of apnea), is indicating either a severe systemic problem (i.e. cardiac arrest) or very severe and extensive central nervous system injury. If you're at 200 feet with either of those, the likelihood of meaningful survival is extremely low. On the other hand, the likelihood of injury to the rescuing diver from blowing the deco on a 200 foot dive is high.

This is one of those where there is no right answer. My guess is that decisions in these circumstances are made as much on emotion as they ever are on rational grounds.

God deliver me from ever having to make such a decision, especially about someone I know well or care about.

[Mark Chase]

Using my settings for deco (10/90GF) Any thing less than 60 Min's deco commitment, its a no brainer just take the diver to the surface.

It important to know the base line for the deco which is why I always take a look at a 100/100GF plan for the dive so I have a rough idea.

I would hope to be able to get the diver to the surface, raise the alarm and then go back down to do my missed deco procedures.

Anything more than that Id need to convince my self there was a point in risking a major bend and ultimately my young kids need a dad.

The diver is already in a bad way so unless he's breathing whats the point in taking him straight up with a 2hour deco commitment owing, the stress of that will surely kill him and likely kill/seriously injure you.

The brain can last about 8mins without 02. so assuming a couple of mins left on the bottom and a min to get sorted you only have 4-5mins to get the diver to the surface and breathing again. From depth this might be impossable without risk of baratrauma.

For me if there is serious deco owing and its deep then it has to be fixed at depth or its a body recovery situation.

ATB

Mark

[Nikos Vardakas]

Quote:

I would hope to be able to get the diver to the surface, raise the alarm and then go back down to do my missed deco procedures.

Mark,
my concern at that stage would be the assistance and coordination being exhibited from the people on the surface if there is. There are numerous of cases where diving is conducted from shore (at least where I live) and no any kind of surface support exists. In this case even bringing the diver on the surface with success one probably did a tremendous effort that leads nowhere. I guess that should have been a significant parameter in the decision making process while on depth.

[Frank Griga]

Would be nice to see nice discussion on this subject. Thanks to everybody who responded already. There are many variables that we have to consider before the final decision was made. The bottom timer will indicate the ongassing time in case an unconscious diver event happened within the team. If the victim was breathing there is a chance for rescuing but we have to keep in mind that it is long way up and variables are not constants. The surface support is mandatory and if missing the chances for rescuing are getting very low.

What about if the victim was not breathing. We will check the bottom timer again that will give us the first input. The question is how long the victim was not breathing. It will be known if someone drowned within the team. We would know how much time was left for the brain cells to start dying.
If the ongassing was relatively short I would say some sort of emergency ascent could be possible and perhaps re-compression could take place. I know, this is another topic for discussion .

If the ongassing time was longer or way too long I would say there was no chance for rescuing and we could only talk about body recovery. However there was a method that I don't really agree with as it is very aggressive one and chances for rescuing are very low.

The feet first ascent where you have to invert the diver and fill the dry suit - and perhaps a little air in the wing. In this way - the diver goes up feet first and the expanding gases can escape from the lungs as the head is free to move about. Expanding gas during the ascent may in effect to some degree kick start the resuscitation or at least clear some of the water from the lungs. Some divers believe that this is the last option and if surface support available the victim could be resuscitated and depending on the depth of the incident he may get bent but he could survive.

From my perspective; if you send the body up as suggested you will most likely kill him/her one more time due to the tissue damage that was caused by expanding bubble formations during the rapid ascent the body did. Still talking about dives below 70m.

Would like to know your opinion about this method too. I still believe the feet first ascent is just the last option where the victim is dead or almost dead.
Will most probably not survive the fast ascent no matter what the position is. If drysuit presented the feet first is possible. If wetsuit was involved would you attach a lift bug to his legs in order to send him feet first? If you inflate the drysuit as well as the wing a bit that could cause the body could change the position during ascent.

Thanks for all valuable inputs. I know this is very sensitive and people will most likely be afraid to answer.

All the best,
Frank

[Nikos Vardakas]

I think at this stage we would look at team capacity to effectively communicate and finally perform in rescuing the victim. Is this intangible skills that are only revealed when a situation rise... we know our skills in handling bottles etc that can be easily revealed because the need to while gas switching, SMB etc, but when it comes to something important and urgent and to a priority driven action is different story. Experience, build on team, careful gas choice and an array of parameters would only add to the accident prevention. Are these cases where unmeasured and invisible skills make the hell of a difference. The issue here whether the team has the potential or not and I think this is why DIR approach can be measured in a backplate and a long hose.

[Nikos Vardakas]

sorry, that is meant to be written can't be measured in a backplate and a long hose…

[Mark Chase]

I tend to dive boats with lifts. Not only because I don't like climbing ladders but also because it makes diver recovery safer. If I have just blown off an hours deco, then once I have the skippers attention and I have confirmed the diver is not lying face down in the water I am going back down for my missed deco.

I am not Mother Teresa and I am not interested in being a hero in a wheel chair. So unless your family, thats the deal.

If I felt the diver had no chance of survival Id try and ascend with him dead but doing all my deco. I feel strongly that a family would be better off with a body to bury and the thought of the dead diver sinking away to be lost is far worse than him just being dead (if that makes sense) I also think it would be better if when the family have to ID the body the diver hadn't suffered explosive decompression. From what I have read its not very nice.

If I couldn't cope Id clip a reel to him and send him up as a last resort.

I think it is important to decide a critical decision point before you get in the water and stick to it. You think a lot clearer on the surface.

There was a recent sad death of a CCR diver / instructor who's buddy passed out at depth. The Diver rescued him to the surface and he survived. Sadly the instructor died in the rescue.

ATB

Mark