Author Topic: Protocol for unconcious diver  (Read 8667 times)

cedricverdier

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Protocol for unconcious diver
« on: May 05, 2006, 05:48:41 AM »
Hi all,

Has anybody ever heard of convulsing rebreather divers who suffered Arterial Gas Embolism after the rescue?

Is there any evidence that bringing a diver during the convulsion could cause any lung overexpansion?

cheers

Offline Eoin OBeara

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Re: Protocol for unconcious diver
« Reply #1 on: May 05, 2006, 09:32:14 AM »
Hi Cedric,
I can't be specific about rebreather divers, not being RB certified myself. I can say (and correct me if I am wrong), that it would depend on whether the epiglotis is open or closed during the ascent. If open, it would allow expanding gasses to escape, if closed it wouldn't.
Ta,
Eoin

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barrie law

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Re: Protocol for unconcious diver
« Reply #2 on: March 12, 2008, 11:48:40 AM »
Quote from: Frank
If you try to do a controlled ascent in an emergency with maybe a disabled/unconscious diver the drysuit will dump all the way up and it can be controlled by the over-pressure valve if you use your wing this needs to be manually dumped and if holding onto a shot line & a diver it is something you can do without.
 
This is theory only and it is misleading. You will have very hard time rescuing unconscious diver from depth. You would need to specify it Barrie a bit more. 1000 scenarios here. Was that RB/OC diver, decompression dive, deep dive, horizontal or vertical trim, was shot line available, was that open water ascent without reference, support available and so on.... This is good subject for another thread. Basically if you do not maintain your buoyancy even if you try you will most probably finish in a decompression chamber. Allan Grejsen that I knew from Denmark had died while rescuing another diver. Both diving Inspiration. He was well respected tech instructor teaching RB courses as well. There is a rule. Don't put your life into danger if you see there is no chance for rescuing.
 
All the best,
Frank

Hi Frank, I think?
 
The point is why do something if you do not need too the emergency ascent with another diver was just a general example and I think Stewie made the point better in his post:
 
"Quote"
I use the dry suit for buoyancy and just tilt my right shoulder down slightly to dump gas (auto dump on left).
[Therefore, I do not have to use any hands at all to control my buoyancy all the way up from very deep dives - constant shoulder angle = constant volume = constant buoyancy]
I do exactly the same for OC dives (wing and suit for surface & suit only underwater).
"Quote"
 
I have never heard of the "Don't put your life in danger" rule and I expect every attempt at rescue especially deeper than 70 mtrs will carry some risk to your own life but I would do everything possible to assist a team member and I am sure they would do the same.
 
There are members here on the Tecdiver Forum who have been involved in emergency situations and have responded in an exemplary manner with more than some risk to themselves and I do applaud their actions even when sadly their efforts only ensured a return to the families of the divers body.
 
You mention Allan Grejsen from Denmark diving CCR could you tell me when & where that was as it does not appear on the CCR fatality database that list's a total of 152 fatalities since 1949 on all types of rebreathers.

Frank

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Re: Protocol for unconcious diver
« Reply #3 on: March 12, 2008, 01:14:50 PM »
Quote from: barrie law
Hi Frank, I think?
 
The point is why do something if you do not need too the emergency ascent with another diver was just a general example and I think Stewie made the point better in his post:

[COLOR="Blue"]That general example could easily be misunderstood by a novice divers. [/COLOR]

 
"Quote"
I use the dry suit for buoyancy and just tilt my right shoulder down slightly to dump gas (auto dump on left).
[Therefore, I do not have to use any hands at all to control my buoyancy all the way up from very deep dives - constant shoulder angle = constant volume = constant buoyancy]
I do exactly the same for OC dives (wing and suit for surface & suit only underwater).
"Quote"

[COLOR="blue"]Stiewie nicely described some of the basic rules that are applicable when diving with drysuit. Anything unknown. I'm diving in horizontal trim with 0 degree angle most of the time if possible. Dump valve on the drusit is fully opened all the time and yes there is minimum gas in the suit. Minimum gas means V-Drill is not an issue. In this position I'm not using inflator hose for dumping air off the wing. Deflating wing with dump valve only. If feet are floaty legs are going down a bit in order to move the air pockets the right direction. There is no work required during the ascend apart from the wing. Even with minimum gas in the wing you will always have some work with your wing.[/COLOR]

 
I have never heard of the "Don't put your life in danger" rule and I expect every attempt at rescue especially deeper than 70 mtrs will carry some risk to your own life but I would do everything possible to assist a team member and I am sure they would do the same.
 
There are members here on the Tecdiver Forum who have been involved in emergency situations and have responded in an exemplary manner with more than some risk to themselves and I do applaud their actions even when sadly their efforts only ensured a return to the families of the divers body.
 
[COLOR="blue"]I said, if you see there is no chance for rescuing. I will open another post for this subject and believe more tekies will respond to it. The rule was introduced to me during OWD course with SDI agency. Perhaps that instructor knew what he was talking about. I believe he was right especially when more difficult dives take place. Some people don't have that experience and playing a hero is not always the right approach. I would not mind helping others but if I see the chance is gone I wouldn't put myself into danger. Simply, one dead diver is enough do you need more? There are some divers between us that had experienced real emergency and left the body behind. It is not easy for anybody to make such decision. It will stay with you for the rest of the life.[/COLOR]


You mention Allan Grejsen from Denmark diving CCR could you tell me when & where that was as it does not appear on the CCR fatality database that list's a total of 152 fatalities since 1949 on all types of rebreathers.


[COLOR="blue"]MV Tala, diving safari, November 2007, group of Danish divers, the accident happened on Rosallie Moller following my Danish friends explanation. I have seen your condolences Barrie just couple of lines below mine ones. Aren't you the rebreatherworld.com sponsor? [/COLOR]
« Last Edit: March 12, 2008, 01:49:11 PM by Frank »

barrie law

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Re: Protocol for unconcious diver
« Reply #4 on: March 12, 2008, 02:43:50 PM »
I have never heard of the "Don't put your life in danger" rule and I expect every attempt at rescue especially deeper than 70 mtrs will carry some risk to your own life but I would do everything possible to assist a team member and I am sure they would do the same.

There are members here on the Tecdiver Forum who have been involved in emergency situations and have responded in an exemplary manner with more than some risk to themselves and I do applaud their actions even when sadly their efforts only ensured a return to the families of the divers body.

I said, if you see there is no chance for rescuing. I will open another post for this subject and believe more tekies will respond to it. The rule was introduced to me during OWD course with SDI agency. Perhaps that instructor knew what he was talking about. I believe he was right especially when more difficult dives take place. Some people don't have that experience and playing a hero is not always the right approach. I would not mind helping others but if I see the chance is gone I wouldn't put myself into danger. Simply, one dead diver is enough do you need more? There are some divers between us that had experienced real emergency and left the body behind. It is not easy for anybody to make such decision. It will stay with you for the rest of the life.

Hi Frank,
 
The point you made was not to put your life in danger "if you see there is no chance for resueing" I do not believe you can make that call unless you at least try and if rescue if not possible at least ensure the body can be found by recovery divers at a later time.
 
The instructor during your OWD course may have been correct to instruct you not to help a stricken diver to avoid injury to yourself but we are talking about Technical divers here who are diving deeper than 70 mtrs who should have the experience to be able to help a diver in difficulty.

Offline Graham Cowley

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Re: Protocol for unconcious diver
« Reply #5 on: March 12, 2008, 04:31:07 PM »
Quote from: barrie law
I have never heard of the "Don't put your life in danger" rule and I expect every attempt at rescue especially deeper than 70 mtrs will carry some risk to your own life but I would do everything possible to assist a team member and I am sure they would do the same.

There are members here on the Tecdiver Forum who have been involved in emergency situations and have responded in an exemplary manner with more than some risk to themselves and I do applaud their actions even when sadly their efforts only ensured a return to the families of the divers body.

I said, if you see there is no chance for rescuing. I will open another post for this subject and believe more tekies will respond to it. The rule was introduced to me during OWD course with SDI agency. Perhaps that instructor knew what he was talking about. I believe he was right especially when more difficult dives take place. Some people don't have that experience and playing a hero is not always the right approach. I would not mind helping others but if I see the chance is gone I wouldn't put myself into danger. Simply, one dead diver is enough do you need more? There are some divers between us that had experienced real emergency and left the body behind. It is not easy for anybody to make such decision. It will stay with you for the rest of the life.

Hi Frank,
 
The point you made was not to put your life in danger "if you see there is no chance for resueing" I do not believe you can make that call unless you at least try and if rescue if not possible at least ensure the body can be found by recovery divers at a later time.
 
The instructor during your OWD course may have been correct to instruct you not to help a stricken diver to avoid injury to yourself but we are talking about Technical divers here who are diving deeper than 70 mtrs who should have the experience to be able to help a diver in difficulty.


I think its only a realistic decision you make when you are placed in it, Ive never had any serious issues in the water as some have experienced,  but if I was diving within a team or just myself and a buddy, I would do what I could within the lines of reasonable risk, if it meant you might get a bend or phyiscally injure yourself, then you would make that call.
Cheers,
Graham

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ph:0868333250

"Don't take life too seriously. You'll never get out of it alive!"

Frank

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Re: Protocol for unconcious diver
« Reply #6 on: March 12, 2008, 05:20:43 PM »
Hi Frank,
 
The point you made was not to put your life in danger "if you see there is no chance for rescuing" I do not believe you can make that call unless you at least try and if rescue if not possible at least ensure the body can be found by recovery divers at a later time.


[COLOR="Blue"]There is no reason for taking body in case mouthpiece was gone and water was inhaled. If the body was found unconscious and gas supply was terminated you would need to make final decision.

It is long way up and only 5 minutes for the brain cells to start dying. I assume that was 70m dive with some sort of deco obligation to deal with. If you knew there was no deco chamber on board... .

If the mouthpiece was in the mouth the chance for waking up unconscious diver would increase. Have got personal experience from Red Sea where an OWD passed out during descent. Was 18m deep, close contact helped to spot this issue so diver was rescued. He woke up during ascent. This was easy and the guy was extremely lucky that myself and DM were next to him all the time.

You are right. I wouldn't leave a guy to die without being fighting for his life. But if I see the fight is lost... yeas I would have one surface marker less in my pocket.[/COLOR]

The instructor during your OWD course may have been correct to instruct you not to help a stricken diver to avoid injury to yourself but we are talking about Technical divers here who are diving deeper than 70 mtrs who should have the experience to be able to help a diver in difficulty.[/QUOTE]

[COLOR="blue"]Lets take a session together in the pool/open water. I will take twinset and 3 stages you can use your RB and all bailout cylinders you need. Such training dives will give us the answers we are looking for and our experience would increace as well. Anyone else to participate?[/COLOR]

Offline Stewart Andrews

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Re: Protocol for unconcious diver
« Reply #7 on: March 13, 2008, 05:34:32 PM »
The unwritten rule, as far as divers with a lot of deco to do and they need to get someone to the surface - where there is some chance of help (after you have done what you can on the bottom) is...

Invert the diver and fill the dry suit - and perhaps a little air in the wing (for final surface support). 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.

A rapid ascent using the wing only, is a head up ascent with the head falling forwards - the unconscious / non-breathing diver's tongue will block the release of air from the airway and a burst lung is the most likely outcome.

Enough gore!

Stewie
Blah blah bladder
Stewie
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Frank

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Re: Protocol for unconcious diver
« Reply #8 on: March 13, 2008, 07:02:42 PM »
Quote from: Stewart Andrews
The unwritten rule, as far as divers with a lot of deco to do and they need to get someone to the surface - where there is some chance of help (after you have done what you can on the bottom) is...

Invert the diver and fill the dry suit - and perhaps a little air in the wing (for final surface support). 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.

A rapid ascent using the wing only, is a head up ascent with the head falling forwards - the unconscious / non-breathing diver's tongue will block the release of air from the airway and a burst lung is the most likely outcome.

Enough gore!

Stewie
Blah blah bladder


Lucky the one where some chance for help was available.

I don't believe this was the best Stewart. I have seen the body of Dave Shaw since it was recovered from depth. It was rapid ascent the body did just the body was much deeper. The deco obligation applies here as well. Fast ascent from depth make sense if the bottom on gassing time was short. There will still be high risk of tissue damage but there is a chance. Checking the unconscious diver bottom timer/computer would help to recognize how long the body was down (still not relevant). Means you will have some info that will help you in making the final decision. You could take into account the cold water effect that could also work for the victim.

If you send the body up as suggested you will most likely kill him one more time due to the tissue damage that was caused by expanding bubble formations during the rapid ascent.

If decompression chamber was not available on board check the time and make decision.

I would escort the body all the way up in case mouthpiece was in when body was found and the time was relatively short. Shooting yellow sausage with request for shallow support that will collect the body. Again if the deco chamber was not available you knew the chances for the victim are very low.

It is way different if the victim was provided with immediate emergency response and deco chamber was available.  I could probably think of re-compression ;-)
« Last Edit: March 13, 2008, 07:12:01 PM by Frank »

barrie law

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Re: Protocol for unconcious diver
« Reply #9 on: March 14, 2008, 12:58:07 AM »
Quote from: Frank
Lucky the one where some chance for help was available.
 
I don't believe this was the best Stewart. I have seen the body of Dave Shaw since it was recovered from depth. It was rapid ascent the body did just the body was much deeper. The deco obligation applies here as well. Fast ascent from depth make sense if the bottom on gassing time was short. There will still be high risk of tissue damage but there is a chance. Checking the unconscious diver bottom timer/computer would help to recognize how long the body was down (still not relevant). Means you will have some info that will help you in making the final decision. You could take into account the cold water effect that could also work for the victim.
 
If you send the body up as suggested you will most likely kill him one more time due to the tissue damage that was caused by expanding bubble formations during the rapid ascent.
 
If decompression chamber was not available on board check the time and make decision.
 
I would escort the body all the way up in case mouthpiece was in when body was found and the time was relatively short. Shooting yellow sausage with request for shallow support that will collect the body. Again if the deco chamber was not available you knew the chances for the victim are very low.
 
It is way different if the victim was provided with immediate emergency response and deco chamber was available. I could probably think of re-compression ;-)

Hi Frank,
 
The situation that Stewart is talking about relates to an incident in real time rather than a body recovery situation and by sending the diver inverted to the surface (even if drowned) there is a real possibility that the surface support may be able to resuscitate the diver and depending on the depth of the incident he may get bent but he could survive.
 
It may help to save the diver when you consider the following factors, an inverted ascent will allow any gas that is present in the lungs to expand during the ascent and may in effect to some degree kick start the resuscitation or at least clear some of the water from the lungs.
 
It is a last ditch effort to recover a diver following an Oxygen Toxicity, Hypercapnia or a drowning incident but sending him up inverted will certainly get him to help on the surface quite quickly and should avoid lung expansion injury (Head up ascent) that would almost certainly result in death.
 
We are talking about best options here in a situation that has occurred despite the best efforts of all concerned and we are ignoring all the planning & training that goes into preparing for these trips and that is already happening now for dives that will not take place until August so just to be clear this really is drastic action when all else has failed.

Frank

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Re: Protocol for unconcious diver
« Reply #10 on: March 14, 2008, 12:17:22 PM »
Hi Barrie,

There are divers that have survived the feet first ascent. They have been left in wheelchair. Do you know where to get some numbers that will say how many didn't survive such ascent and how many were crippled? I was just wondering if such statistic exists.

I believe that any situation under water when dealing with an emergency is a real time and life threatening situation. We would need to specify when exactly a happy diver will turn into unconscious diver. When diving as a team where communication is working and situational awareness is presented at high level then most of the emergencies could be handled without effort in case team members were appropriately trained.

If divers were not co-operating while diving then it could easily happen that by CO2 or high PPO2 affected diver will be left unnoticed in the first and most important seconds. Those two basic issues that most of the tekies are prepared for should normally be resolved if adequate response was presented. Divers could terminate and finish the dive as normal.

If CO2 or high PPO2 was not handled due to the panic and stress that had developed than it could easily happen that divers will be watching their drowning and dying friend. If it goes that far let say they could send him up. That would require somebody from the boat keeping an eye for such event. I believe this is not an issue on any charter boat. Experienced teams and group of divers usually have some sort of emergency scenarios prepared and are ready to deal with them. I was just thinking of divers where boat was left alone as everybody was diving. Unfortunately this is also happening and sending a body up would not make sense.

Happy diver shouldn?t ever become an unconscious diver if poor planning, non existing team work, very bad diving, and solo diving were not presented. Well unless there was a heard attack or stroke strike or another medical predisposition for instance PFO involved.

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?

All the Best,
Frank

Quote from: barrie law
Hi Frank,
 
The situation that Stewart is talking about relates to an incident in real time rather than a body recovery situation and by sending the diver inverted to the surface (even if drowned) there is a real possibility that the surface support may be able to resuscitate the diver and depending on the depth of the incident he may get bent but he could survive.
 
It may help to save the diver when you consider the following factors, an inverted ascent will allow any gas that is present in the lungs to expand during the ascent and may in effect to some degree kick start the resuscitation or at least clear some of the water from the lungs.
 
It is a last ditch effort to recover a diver following an Oxygen Toxicity, Hypercapnia or a drowning incident but sending him up inverted will certainly get him to help on the surface quite quickly and should avoid lung expansion injury (Head up ascent) that would almost certainly result in death.
 
We are talking about best options here in a situation that has occurred despite the best efforts of all concerned and we are ignoring all the planning & training that goes into preparing for these trips and that is already happening now for dives that will not take place until August so just to be clear this really is drastic action when all else has failed.

Frank

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Re: Protocol for unconcious diver
« Reply #11 on: March 18, 2008, 11:28:01 AM »
Hi Lads,

There was a short discussion about rescuing unconscious diver last week. In following video you will see a rescuer using vertical trim for ascent. Not sure who is the author but I found this video interesting.

toxing diver rescue


All the best,
Frank
« Last Edit: September 14, 2011, 12:41:22 AM by admin »

barrie law

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Re: Protocol for unconcious diver
« Reply #12 on: March 18, 2008, 11:53:03 AM »
Quote from: Frank
Hi Lads,
 
There was a short discussion about rescuing unconscious diver last week. In following video you will see a rescuer using vertical trim for ascent. Not sure who is the author but I found this video interesting.
 
http://uk.youtube.com/watch?v=BnzUoQ8ajJU
 
All the best,
Frank

 
Hi Frank,
 
The video shows a drill and this looks nothing like a true Ox Tox incident at best it is a training exercise and at worst it is a misleading post that has absolutely nothing to do with the previous thread about inverting divers who otherwise would die and certainly would be dead if an assisted ascent from 70+ mtrs was attempted.
 
I was very disappointed to get a call from the diver who had posted some of the points in that thread to say he felt uncomfortable posting anything further as your replies seemed argumentative and inexperienced and the discussion stopped dead! This is not what a forum is about and I would ask you to participate in discussions based on your own experiences and not quoting some point your OWD instructor made that has no bearing in a technical diving situation and may I remind you this Forum is to promote Technical Diving in Ireland from all agencies and not just for you to wave a GUE flag the assertion that you are doing it right and everybody else is doing it wrong frankly is wearing a bit thin.

Offline Kevin Deady

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Re: Protocol for unconcious diver
« Reply #13 on: March 18, 2008, 12:05:18 PM »
Hi Guys,

There was an interesting article written by Super Cedric and put on rebreatherworld. It talks about the stages of a tox fit and goes into some scenarios.

I thought it was a decent article.

Kevin.
Regards,
Kevin.

kevin.deady@gmail.com

Offline Stephen McMullan

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Re: Protocol for unconcious diver
« Reply #14 on: March 18, 2008, 12:07:57 PM »
Hi Frank,

I watched that with sound off so maybe I missed something but to me it looks very similar (excepting the reg replacement) to a Controlled Buoyant Lift (CBL) technique thats taught and examined on every BSAC club course from Ocean Diver (CMAS *) upwards.

I simulated an unconcious CCR diver at 10m and my buddy lifted me but it was not controlled as she was unfamiliar with the managing the expansion of the gas spaces on the unit. We've more practice to do. You can have a go too the next time I see you.

Its not within my experience range admittedly but I'm with Barrie on the inversion. We received specific instruction on that technique in MOD1. I might get my buddy to try it out for the laugh from 10m once she's nailed the upright technique.

All the best, Stephen

 

     
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